Abstract 13790: Long-Term Mortality After Acute Myocardial Infarction According to Presence of Modifiable Risk Factors

Abstract

Introduction: Acute myocardial infarction (AMI) in the absence of modifiable risk factors (MRF) might have a poorer outcome. Methods: we assessed long-term survival in the FAST-MI program (3 nationwide French prospective surveys carried out 5 years apart from 2005 to 2015, consecutively including STEMI and NSTEMI patients ≤48 hours from onset, over 1-month periods), according to presence/absence of MRF (current smoking, hypertension, diabetes, obesity or hypercholesterolemia/statin use). Results: Of 13,310 patients included, 9,599 had no history of CAD, of whom 1503 (15.6%) had no MRF; they were older (66 ± 13 vs 64 ± 14 years, P<0.001) with similar GRACE score (141 ± 33 vs 140 ± 36, P=0.54) and LVEF (52 ± 11 vs 53 ± 11, P=0.17), were more frequently men (74 vs 70%, P=0.001) and had more often STEMI (63 vs 58%, P<0.001). Use of coronary angiography and PCI did not differ, 1-vessel disease was more common in patients without MRF (58 vs 52%, P<0.001); at discharge, statin (90 vs 90.5%; moderate/high dose 69 vs 67%), dual antiplatelet (84 vs 85%) and beta-blocker (85 vs 84%) use did not differ, while fewer received ACEi or ARBs (72 vs 75%, P=0.03). At a mean follow-up of 54 months, survival was higher in patients without MRF (88 vs 84%, P<0.001); NSTEMI patients (89 vs 81%, P<0.001), STEMI patients (88 vs 86%, P=0.21) (Figure). After adjustment on baseline variables, absence of MRF was not associated with long-term mortality (HR 0.88, 95%CI 0.72-1.09); however, when also including early management, LVEF and CAD extent in the model, absence of MRF was associated with lower mortality (HR 0.76, 95%CI 0.62-0.92, P<0.001). Conclusion: the management of patients with AMI is very similar, whether they have MRF or not. Long-term survival does not differ among patients with or without MRF. After taking into account early management, however, presence of MRF is associated with worse outcome, suggesting that more intensive treatment might be needed when AMI occurs in patients with documented risk factors.