Abstract 16356: Higher Mortality Up to 36 Months in ST-Segment Elevation Myocardial Infarction Patients Without Standard Modifiable Risk Factors: Results From the SWEDEHEART Registry

Abstract

Introduction: While prevention strategies that target S tandard M odifiable cardiovasc u lar R isk F actors (SMuRFs: hypertension, diabetes mellitus, hypercholesterolemia, smoking) are critical to reduce coronary heart disease risk, myocardial infarction (MI) in the absence of SMuRFs is not infrequent. Methods: We examined the presenting features, treatment, short- and long-term outcomes of patients with ST-segment-elevation MI (STEMI) without SMuRFs compared to STEMI patients with >0 SMuRFs in the national Swedish MI registry SWEDEHEART between 2006-2018. Adjusted logistic regression models were used to determine outcome predictors of all cause 30-day mortality. Kaplan Meir survival analysis was performed. Results: 8,400 (14%) of 60,692 patients without a history of coronary artery disease had no SMuRFs. Patients with and without SMuRFs had the same rate of primary PCI but lower rate of multivessel disease (37% vs. 44%). SMuRF-less patients had higher rates of unadjusted all-cause mortality at 30 days (12% vs. 8%, P <0.0001) and at 36 months (20% vs. 17%, P <0.0001). In adjusted models, having SMuRFs vs. being SMuRF-less (OR 0.63 [95% CI 0.54-0.73]), female sex, LVEF <40%, pre-hospital cardiac arrest, higher heart rate and creatinine, and lower systolic blood pressure were predictors of 30-day mortality (P <0.0001 for all). All-cause mortality rate at 30 days was highest among SMuRF-less females and those with LVEF <40% (Figure 1). The proportion on preventive pharmacotherapy at discharge was lower in SMuRF-less patients. Conclusions: 14% of STEMI presentations occurred in the absence of SMuRFs. Higher rates of 30-day mortality in SMuRF-less STEMI patients, especially among women, highlight the need for improved risk stratification and evidence-based pharmacotherapy during the post MI period, irrespective of baseline risk factors and sex. Figure 1. Kaplan Meier survival curves for patients with and without SMuRFs. A) Women. B) Men. C) LVEF < 40%. D) LVEF > 40%.