背景:标准可调节心血管危险因素(SMuRF),如高血压,糖尿病,高脂血症,和吸烟早已确立了动脉粥样硬化疾病的病因。我们评估了没有这些危险因素的女性STEMI患者的院内预后。
方法:查询全国住院患者样本数据库(2016年至2021年),以使用ICD10代码将STEMI入院确定为主要诊断。有冠心病病史的患者,心肌梗塞,冠状动脉旁路移植术,经皮冠状动脉介入治疗,takotsubo心肌病,滥用可卡因,自发性冠状动脉夹层和男性被排除在我们的研究人群之外。根据存在≥1个危险因素,将年龄>18岁的最终研究人群分为SMuRF和SMuRF-less队列。调整基线特征和合并症的多变量逻辑回归模型。主要结果是院内死亡率。次要结果是STEMI相关并发症,以及机械循环支持装置的使用。
结果:确定了200,980例患者。187,776例(93.4%)患者被确定为具有≥1个SMuRF,13,205(6.6%)例患者无SMuRF。与SMuRF患者相比,无SMuRF的患者更有可能是白人(75.6%与73.1%,p<0.01)和年龄中位数(69岁[IQR:58-78]vs67岁[IQR:57-81],p<0.01)。在比较合并症时,无SMuRF患者患心力衰竭的可能性较小(28.0%vs.23.4%,p<0.01),心房颤动/扑动(16.1%vs.14.6%,p=0.03),慢性肺病(18.9%vs.9.5%,p<0.01),肥胖症(20.7%vs.9.2%,p<0.01)和主动脉疾病(1.1%vs.0.6%,p<0.01)。然而,他们更有可能患痴呆症(6.9%vs.5.7%,p<0.01)。在评估结果时,无SMuRF患者住院死亡率较高(aOR3.2[95%CI,2.9-3.6];P<0.01),急性心力衰竭(aOR1.6[95%CI,1.4-1.8];P<0.01),急性肾损伤(aOR1.8[95%CI,1.7-2.1];P<0.01),和主动脉内球囊反搏(aOR1.7[95%CI,1.5-1.9];P<0.01)。无SMuRF患者死亡率较高的预测因素包括慢性肝病(OR6.8,CI2.4-19.4,p<0.01),和西班牙裔种族(OR1.62,CI1.1-2.5,p<0.01)。我们还发现,缺乏SMuRF的患者不太可能接受冠状动脉造影(aOR为0.5[95%CI,0.4-0.5];P<0.01)和经皮冠状动脉介入治疗(aOR为0.7[95%CI,0.6-0.8];P<0.01)。
结论:与≥1SMuRF的患者相比,出现STEMI的女性SMuRF少患者的院内预后更差。
BACKGROUND: Standard Modifiable Cardiovascular Risk Factors (SMuRF) such as hypertension, diabetes mellitus, hyperlipidemia, and smoking have long been established in the etiology of atherosclerotic disease. We evaluate in-hospital outcomes of female STEMI patients without these risk factors.
METHODS: The National Inpatient Sample databases (2016 to 2021) were queried to identify STEMI admissions as a principal diagnosis using ICD 10 codes. Patients with a history of coronary artery disease, myocardial infarction, coronary bypass graft, percutaneous coronary intervention, takotsubo cardiomyopathy, cocaine abuse, and spontaneous coronary dissection and males were excluded from our study population. A final study population aged >18 years was divided into cohorts of SMuRF and SMuRF-less based on the presence of ≥1 risk factor. Multivariate logistic regression model adjusting for baseline characteristics and comorbidities. The primary outcome was in-hospital mortality. The secondary outcomes are STEMI-related complications, and the use of mechanical circulatory support devices.
RESULTS: 200,980 patients were identified. 187,776 (93.4%) patients were identified as having ≥1 SMuRF, and 13,205 (6.6%) patients were SMuRF-less. Compared to SMuRF patients, SMuRF-less patients are more likely to be white (75.6% vs. 73.1%, p<0.01) and older median age (69 years [IQR: 58-78] vs 67 years [IQR: 57-81], p<0.01). In comparing co-morbidities, SMuRF-less patients were less likely to have heart failure (28.0% vs. 23.4%, p<0.01), atrial fibrillation/flutter (16.1% vs. 14.6%, p=0.03), chronic pulmonary disease (18.9% vs. 9.5%, p<0.01), obesity (20.7% vs. 9.2%, p<0.01) and aortic disease (1.1% vs. 0.6%, p<0.01). They were however more likely to have dementia (6.9% vs. 5.7%, p<0.01). In evaluating outcomes, SMuRF-less patients had higher in-hospital mortality (aOR 3.2 [95% CI, 2.9 - 3.6]; P<0.01), acute heart failure (aOR 1.6 [95% CI, 1.4 - 1.8]; P<0.01), acute kidney injury (aOR 1.8 [95% CI, 1.7 - 2.1]; P<0.01), and Intra-aortic balloon pump (aOR 1.7 [95% CI, 1.5 - 1.9]; P<0.01). Predictors of higher mortality in SMuRF-less patients include chronic liver disease (OR 6.8, CI 2.4-19.4, p<0.01), and Hispanic race (OR 1.62, CI 1.1-2.5, p<0.01). We also found that SMuRF-less patients were less likely to undergo coronary angiography (aOR 0.5 [95% CI, 0.4 - 0.5]; P<0.01) and percutaneous coronary intervention (aOR 0.7 [95% CI, 0.6 - 0.8]; P<0.01).
CONCLUSIONS: Female SMuRF-less patients presenting with STEMI have worse in-hospital outcomes when compared to patients with ≥1SMuRF.