Signature of standard modifiable CV factors as unrecognizable risk factor of in-hospital mortality in patients with acute myocardial infarction
2022; Elsevier BV; Volume: 371; Linguagem: Inglês
10.1016/j.ijcard.2022.10.010
ISSN1874-1754
Autores Tópico(s)Cardiac Health and Mental Health
ResumoClinical outcomes in patients with ST-elevation myocardial infarction (STEMI) remain challenging and are often associated with a large number causative factors including not only age, gender, coronary anatomy, severity of atherothrombosis, cardiac complications, a quality of management, particularities of health system and its affordability, but also coexisting comorbidities and a spectrum of cardiovascular (CV) and non-CV risk factors [ [1] Tsao C.W. Aday A.W. Almarzooq Z.I. Alonso A. Beaton A.Z. Bittencourt M.S. et al. Heart Disease and Stroke Statistics-2022 update: a report from the American Heart Association. Circulation. 2022; 145: e153-e639https://doi.org/10.1161/CIR.0000000000001052 Crossref PubMed Scopus (1412) Google Scholar ]. Indeed, the first episode of STEMI may relate to a poor in-hospital mortality through a presentation of standard modifiable CV factors (SMuRFs) [ [2] Shrestha B. Mochon A. Poudel B. Poudel D. Donato A. Trends and outcomes of ST-segment-elevation MI in hospitalized patients without standard modifiable cardiovascular risk factors. Curr. Probl. Cardiol. 2022; 47101271https://doi.org/10.1016/j.cpcardiol.2022.101271 Crossref Scopus (5) Google Scholar ]. Previous studies have unexpectedly established that type 1 STEMI / acute myocardial infarction (AMI), which occurred in result of a rupture of vulnerable atherosclerotic plaque and occlusive thrombosis, frequently exerted worse in-hospital outcomes in patients with an absence of SMuRFs [ [3] Ando T. Akintoye E. Adegbala O. Ashraf S. Shokr M. Takagi H. et al. In-hospital outcomes of ST-segment elevation myocardial infarction complicated with cardiogenic shock at safety-net hospitals in the United States (from the Nationwide inpatient sample). Am. J. Cardiol. 2019; 124: 485-490https://doi.org/10.1016/j.amjcard.2019.05.037 Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar , [4] Vernon S.T. Coffey S. Bhindi R. Soo Hoo S.Y. Nelson G.I. Ward M.R. et al. Increasing proportion of ST elevation myocardial infarction patients with coronary atherosclerosis poorly explained by standard modifiable risk factors. Eur. J. Prev. Cardiol. 2017; 24: 1824-1830https://doi.org/10.1177/2047487317720287 Crossref PubMed Scopus (84) Google Scholar ]. To up to date our knowledge, there is evidence of the fact that the STEMI patients with poor clinical outcome in an absence of SMuRFs versus those with SMuRFs were younger, more likely men with underweight (body mass index <20 kg/m2) and more frequently ethnic minorities (mainly Black or Hispanic) [ [3] Ando T. Akintoye E. Adegbala O. Ashraf S. Shokr M. Takagi H. et al. In-hospital outcomes of ST-segment elevation myocardial infarction complicated with cardiogenic shock at safety-net hospitals in the United States (from the Nationwide inpatient sample). Am. J. Cardiol. 2019; 124: 485-490https://doi.org/10.1016/j.amjcard.2019.05.037 Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar ], whereas other data indicate that this vulnerable population of SMuRF-less STEMI / AMI patients composed of rather white male than ethnic minority ones [ [2] Shrestha B. Mochon A. Poudel B. Poudel D. Donato A. Trends and outcomes of ST-segment-elevation MI in hospitalized patients without standard modifiable cardiovascular risk factors. Curr. Probl. Cardiol. 2022; 47101271https://doi.org/10.1016/j.cpcardiol.2022.101271 Crossref Scopus (5) Google Scholar , [4] Vernon S.T. Coffey S. Bhindi R. Soo Hoo S.Y. Nelson G.I. Ward M.R. et al. Increasing proportion of ST elevation myocardial infarction patients with coronary atherosclerosis poorly explained by standard modifiable risk factors. Eur. J. Prev. Cardiol. 2017; 24: 1824-1830https://doi.org/10.1177/2047487317720287 Crossref PubMed Scopus (84) Google Scholar ]. Yet, some authors noticed that among SMuRF-less STEMI patients percutaneous coronary interventions (PCI) were less performed, whereas frequencies of coronary artery bypass grafting and the use of mechanical circulatory support were similar [ [3] Ando T. Akintoye E. Adegbala O. Ashraf S. Shokr M. Takagi H. et al. In-hospital outcomes of ST-segment elevation myocardial infarction complicated with cardiogenic shock at safety-net hospitals in the United States (from the Nationwide inpatient sample). Am. J. Cardiol. 2019; 124: 485-490https://doi.org/10.1016/j.amjcard.2019.05.037 Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar , [4] Vernon S.T. Coffey S. Bhindi R. Soo Hoo S.Y. Nelson G.I. Ward M.R. et al. Increasing proportion of ST elevation myocardial infarction patients with coronary atherosclerosis poorly explained by standard modifiable risk factors. Eur. J. Prev. Cardiol. 2017; 24: 1824-1830https://doi.org/10.1177/2047487317720287 Crossref PubMed Scopus (84) Google Scholar ]. At the same time, in-hospital mortality rate was significantly elevated in a group of STEMI patients without SMuRFs when compared with those with SMuRFs, whereas new cases of dialysis, non-fatal stroke, and fatal arrhythmias were similar [ [3] Ando T. Akintoye E. Adegbala O. Ashraf S. Shokr M. Takagi H. et al. In-hospital outcomes of ST-segment elevation myocardial infarction complicated with cardiogenic shock at safety-net hospitals in the United States (from the Nationwide inpatient sample). Am. J. Cardiol. 2019; 124: 485-490https://doi.org/10.1016/j.amjcard.2019.05.037 Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar , [4] Vernon S.T. Coffey S. Bhindi R. Soo Hoo S.Y. Nelson G.I. Ward M.R. et al. Increasing proportion of ST elevation myocardial infarction patients with coronary atherosclerosis poorly explained by standard modifiable risk factors. Eur. J. Prev. Cardiol. 2017; 24: 1824-1830https://doi.org/10.1177/2047487317720287 Crossref PubMed Scopus (84) Google Scholar ]. The majority of investigators believe that SMuRF-less patients with type 1 AMI represent higher mortality due to significantly higher number of cardiac complications, such as cardiogenic shock, fatal ventricular arrhythmia, cardiac arrest, and receiving fewer invasive procedures including PCI or delaying PCI [ 2 Shrestha B. Mochon A. Poudel B. Poudel D. Donato A. Trends and outcomes of ST-segment-elevation MI in hospitalized patients without standard modifiable cardiovascular risk factors. Curr. Probl. Cardiol. 2022; 47101271https://doi.org/10.1016/j.cpcardiol.2022.101271 Crossref Scopus (5) Google Scholar , 3 Ando T. Akintoye E. Adegbala O. Ashraf S. Shokr M. Takagi H. et al. In-hospital outcomes of ST-segment elevation myocardial infarction complicated with cardiogenic shock at safety-net hospitals in the United States (from the Nationwide inpatient sample). Am. J. Cardiol. 2019; 124: 485-490https://doi.org/10.1016/j.amjcard.2019.05.037 Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar , 4 Vernon S.T. Coffey S. Bhindi R. Soo Hoo S.Y. Nelson G.I. Ward M.R. et al. Increasing proportion of ST elevation myocardial infarction patients with coronary atherosclerosis poorly explained by standard modifiable risk factors. Eur. J. Prev. Cardiol. 2017; 24: 1824-1830https://doi.org/10.1177/2047487317720287 Crossref PubMed Scopus (84) Google Scholar ]. In addition to that, there is an assumption that a relationship between an absence of SMuRFs and increased risk of mortality among in-patients with type 1 AMI may be explained by a difference in aging of the groups, but not only delaying PCI and other management [ [5] Moledina S.M. Rashid M. Nolan J. Nakao K. Sun L.Y. Velagapudi P. et al. Addressing disparities of care in non-ST-segment elevation myocardial infarction patients without standard modifiable risk factors: insights from a nationwide cohort study. Eur. J. Prev. Cardiol. 2022; 29: 1084-1092https://doi.org/10.1093/eurjpc/zwab200 Crossref PubMed Scopus (17) Google Scholar , [6] Figtree G.A. Vernon S.T. Hadziosmanovic N. Sundström J. Alfredsson J. Arnott C. et al. Mortality in STEMI patients without standard modifiable risk factors: a sex-disaggregated analysis of SWEDEHEART registry data. Lancet. 2021; 397: 1085-1094https://doi.org/10.1016/S0140-6736(21)00272-5 Abstract Full Text Full Text PDF PubMed Scopus (104) Google Scholar ]. In fact, plausible reasons that may be clearly explain pathogenetic pathways tackling SMuRF signature with in-hospital mortality in AMI depending on its types seem to shown uncertainty and require deep investigation. Fig. 1 summarizes several interrelation between presentation of SMuRF and in-hospital clinical outcomes of type 1 / type 2 - STEMI/AMI.
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