Mortality in ST-segment elevation myocardial infarction patients without standard modifiable risk factors: A race disaggregated analysis. (December 2022)

• Record Type: Journal Article
• Authors: Moledina, Saadiq M.; Kobo, Ofer; Lakhani, Hammad; Abhishek, Abhishek; Parwani, Purvi; Santos Volgman, Annabelle; Bond, Rachel M.; Rashid, Muhammad; Figtree, Gemma A.; Mamas, Mamas A.
• Is Part Of: IJC heart & vasculature. Volume 43(2023)
• Publication Date: 2022-12
• Subjects: STEMI -- Race -- SMuRF -- Quality of care; Cardiovascular system -- Diseases -- Periodicals; Cardiovascular system -- Pathophysiology -- Periodicals; 616.1005
• DOI: 10.1016/j.ijcha.2022.101135
• Languages: English
• ISSNs: 2352-9067

Abstract

Abstract: Background: Individuals who present with STEMI without the standard cardiovascular risk factors (SMuRFs) of diabetes, hypercholesterolemia, hypertension, and smoking, coined SMuRF-less are not uncommon. Little is known about their outcomes as a cohort and how they differ by race. Methods & Results: We identified 431, 615 admissions with STEMI in the National Inpatient Sample (NIS) database 2015–2018, including patients with ≥ 1 SMuRF (n = 369, 870) and those who were SMuRF-less (n = 234, 745). SMuRF-less patients presented at a similar age (median age 63y vs 63y), were less likely to be female (33.6 % vs 34.6 %) and were almost twice as likely to present as a cardiac arrest (13.7 % vs 7.0 %), than those with ≥ 1 SMuRFs. SMuRF-less patients were less frequently in receipt of ICA (71.3 % vs 83.8 %) and PCI (58.0 % vs 72.2 %) compared to those with ≥ 1 SMuRF. Our race disaggregated analysis showed ethnic minority SMuRF-less patients were less likely than White patients to receive ICA and PCI, which was most apparent in Black patients with reduced odds of ICA (OR: 0.47, 95 % CI: 0.43–0.52) and PCI (OR: 0.46, 95 % CI: 0.52–0.50). Similarly, in ethnic minority subgroups within the SMuRF-less cohort, mortality and MACCE were significantly higher than in White patients. This was most profound in Black patients with in-hospital mortality (OR: 1.90, 95 % CI: 1.72–2.09) and MACCE (OR: 1.63, 95 % CI: 1.49–1.78) compared to White patients. Conclusion: Ethnic Minority SMuRF-less patients were less likely than White SMuRF-less patients to receive ICA and PCI and had worse mortality outcomes.