PDF(Pubmed)
Abstract：
UNASSIGNED: Little is known of the characteristics, treatment, and outcomes of patients with ST-segment elevation myocardial infarction (STEMI) but without standard modifiable cardiovascular risk factors (SMuRFs, including smoking, hypercholesterolemia, diabetes, and hypertension) in developing countries like China. Moreover, contributors to the excess mortality of such SMuRF-less patients remain unclear.
UNASSIGNED: This study was based on a nationally representative sample of patients presenting with STEMI and admitted to 162 hospitals in 31 provinces across mainland China between 2001 and 2015. We compared clinical characteristics, treatments, and mortality during hospitalization between patients with and without SMuRFs. We also investigated the possible causes of differences in mortality and quantified the contributors to excess mortality.
UNASSIGNED: Among 16,541 patients (aged 65 ± 13 years; 30.0% women), 19.9% were SMuRF-less. These patients were older (69 vs. 65 years), experienced more cardiogenic shock and lower blood pressure at admission, and were less likely to be admitted to the cardiac ward compared to patients with SMuRFs. Moreover, SMuRF-less patients received treatment less often, including primary percutaneous coronary intervention (17.3% vs. 28.8%, p < 0.001), dual antiplatelet therapy (59.4% vs. 77.0%, p < 0.001), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (49.9% vs. 68.1%, p < 0.001), and statins (69.9% vs. 85.1%, p < 0.001). They had higher in-hospital mortality (18.5% vs. 10.5%, p < 0.001), with 56.1% of deaths occurring within 24 hours of admission. Although the difference in mortality decreased after adjusting for patient characteristics, it remained significant and concerning (odds ratio (OR) 1.41; 95% confidence interval (CI) 1.25-1.59). Mediation analysis found that, in patients without SMuRFs, underutilization of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and statins contributed to an excess mortality risk of 22.4% and 32.5%, respectively.
UNASSIGNED: Attention and action are urgently needed for STEMI patients without SMuRFs, given their high incidence and excess in-hospital mortality. The use of timely and adequate evidence-based treatments should be strengthened.
UNASSIGNED: This study was based on a nationally representative sample of patients presenting with STEMI and admitted to 162 hospitals in 31 provinces across mainland China between 2001 and 2015. We compared clinical characteristics, treatments, and mortality during hospitalization between patients with and without SMuRFs. We also investigated the possible causes of differences in mortality and quantified the contributors to excess mortality.
UNASSIGNED: Among 16,541 patients (aged 65 ± 13 years; 30.0% women), 19.9% were SMuRF-less. These patients were older (69 vs. 65 years), experienced more cardiogenic shock and lower blood pressure at admission, and were less likely to be admitted to the cardiac ward compared to patients with SMuRFs. Moreover, SMuRF-less patients received treatment less often, including primary percutaneous coronary intervention (17.3% vs. 28.8%, p < 0.001), dual antiplatelet therapy (59.4% vs. 77.0%, p < 0.001), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (49.9% vs. 68.1%, p < 0.001), and statins (69.9% vs. 85.1%, p < 0.001). They had higher in-hospital mortality (18.5% vs. 10.5%, p < 0.001), with 56.1% of deaths occurring within 24 hours of admission. Although the difference in mortality decreased after adjusting for patient characteristics, it remained significant and concerning (odds ratio (OR) 1.41; 95% confidence interval (CI) 1.25-1.59). Mediation analysis found that, in patients without SMuRFs, underutilization of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and statins contributed to an excess mortality risk of 22.4% and 32.5%, respectively.
UNASSIGNED: Attention and action are urgently needed for STEMI patients without SMuRFs, given their high incidence and excess in-hospital mortality. The use of timely and adequate evidence-based treatments should be strengthened.
摘要：
■对这些特征知之甚少，治疗,和ST段抬高型心肌梗死（STEMI）但没有标准可改变心血管危险因素的患者的结局（SMuRFs，包括吸烟,高胆固醇血症,糖尿病,和高血压)在像中国这样的发展中国家。此外，此类无SMuRF患者的超额死亡率的原因尚不清楚。
本研究基于2001年至2015年间中国大陆31个省份的162家医院收治的STEMI患者的全国代表性样本。我们比较了临床特征，治疗,有和没有SMuRFs的患者住院期间的死亡率。我们还调查了死亡率差异的可能原因，并量化了死亡率过高的原因。
■在16,541名患者（年龄65±13岁；30.0％的女性）中，19.9%为SMuRF-less。这些患者年龄较大（69vs.65岁),入院时经历了更多的心源性休克和更低的血压，与患有SMuRFs的患者相比，进入心脏病房的可能性较小。此外，缺乏SMuRF的患者接受治疗的频率较低，包括初次经皮冠状动脉介入治疗（17.3%vs.28.8%,p<0.001)，双重抗血小板治疗（59.4%vs.77.0%,p<0.001)，血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（49.9%vs.68.1%,p<0.001)，和他汀类药物（69.9%vs.85.1%,p<0.001)。他们的住院死亡率更高(18.5%vs.10.5%,p<0.001)，56.1%的死亡发生在入院后24小时内。尽管在调整患者特征后死亡率差异有所下降，它仍然显著且令人担忧(比值比(OR)1.41;95%置信区间(CI)1.25-1.59).中介分析发现,在没有SMuRF的患者中，血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂和他汀类药物的使用不足导致22.4％和32.5％的超额死亡风险，分别。
■对于没有SMuRF的STEMI患者，迫切需要注意和采取行动。考虑到它们的高发病率和过高的院内死亡率。应加强及时和充分的循证治疗。
本研究基于2001年至2015年间中国大陆31个省份的162家医院收治的STEMI患者的全国代表性样本。我们比较了临床特征，治疗,有和没有SMuRFs的患者住院期间的死亡率。我们还调查了死亡率差异的可能原因，并量化了死亡率过高的原因。
■在16,541名患者（年龄65±13岁；30.0％的女性）中，19.9%为SMuRF-less。这些患者年龄较大（69vs.65岁),入院时经历了更多的心源性休克和更低的血压，与患有SMuRFs的患者相比，进入心脏病房的可能性较小。此外，缺乏SMuRF的患者接受治疗的频率较低，包括初次经皮冠状动脉介入治疗（17.3%vs.28.8%,p<0.001)，双重抗血小板治疗（59.4%vs.77.0%,p<0.001)，血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（49.9%vs.68.1%,p<0.001)，和他汀类药物（69.9%vs.85.1%,p<0.001)。他们的住院死亡率更高(18.5%vs.10.5%,p<0.001)，56.1%的死亡发生在入院后24小时内。尽管在调整患者特征后死亡率差异有所下降，它仍然显著且令人担忧(比值比(OR)1.41;95%置信区间(CI)1.25-1.59).中介分析发现,在没有SMuRF的患者中，血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂和他汀类药物的使用不足导致22.4％和32.5％的超额死亡风险，分别。
■对于没有SMuRF的STEMI患者，迫切需要注意和采取行动。考虑到它们的高发病率和过高的院内死亡率。应加强及时和充分的循证治疗。
