Patients with STEMI, no modifiable CV risk factors at elevated mortality risk
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Patients presenting with STEMI who do not have standard modifiable CV risk factors are at elevated risk for all-cause mortality, according to results published in The Lancet.
“In coronary artery disease, targeted strategies against the well-recognized modifiable risk factors of diabetes, hypercholesterolemia, hypertension and smoking (known as the standard modifiable cardiovascular risk factors) have led to major improvements in prevention and treatment,” Gemma A. Figtree, MBBS, from the Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, and colleagues wrote. “However, a clinically significant proportion of patients present with life-threatening myocardial infarction with no previous symptoms, and none of the standard modifiable CV risk factors at or greater than diagnostic thresholds.”
In a retrospective study, researchers analyzed 62,048 adult patients with STEMI (33% women) from the SWEDEHEART registry to compare the outcomes of patients presenting with standard modifiable CV risk factors (85.1%; mean age, 68 years) and patients presenting without standard modifiable CV risk factors (14.9%; mean age, 69 years).
The primary outcome was all-cause mortality at 30 days after STEMI presentation; secondary outcomes included CV mortality, HF and MI at 30 days after STEMI presentation. Researchers followed patients for as long as 12 years.
At 30 days, all-cause mortality was higher in patients without standard modifiable CV risk factors than in those with them (HR= 1.47; 95% CI, 1.37-1.57; P < .0001).
Researchers noted the highest 30-day mortality rate was in women without standard modifiable CV risk factors (17.6%), followed by women with standard modifiable CV risk factors (11.1%), men without standard modifiable CV risk factors (9.3%) and men with standard modifiable CV risk factors (6.1%).
Further, patients without standard modifiable CV risk factors had a higher rate of in-hospital all-cause mortality compared with patients with one or more standard modifiable CV risk factors (9.6% vs. 6.5%; P < .0001). Among patients without standard modifiable CV risk factors, all-cause mortality rates remained elevated in men for more than 8 years and in women for up to 12 years.
“These patients, particularly standard modifiable CV risk factor-less women, have a higher risk of mortality compared with patients with STEMI who have at least one standard risk factor,” Figtree and colleagues wrote. “These findings counter the common assumption that lower traditional risk for atherosclerosis equates to lower risk after myocardial infarction and highlight the need for evidence-based pharmacotherapy during the immediate post-infarct period irrespective of baseline risk factors or sex.”
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