Abstract 9695: Characteristics, Treatment, and Mortality of Patients Hospitalized for ST-Elevation Myocardial Infarction Without Standard Modifiable Cardiovascular Risk Factors in China

Abstract

Introduction: Previous studies found that a substantial proportion of ST-elevation myocardial infarction (STEMI) patients with no standard modifiable cardiovascular risk factors (SMuRFs: hypertension, diabetes mellitus, hypercholesterolemia, smoking) at admission, had unexpected higher mortality compared with those with SMuRFs. However, little is known about what contributed to the excess risk of SMuRF-less patients. Methods: This study used a two-stage random sampling design to create a nationally representative sample of patients admitted with STEMI in China, from 2001 to 2015. We compared patient characteristics, treatments, and in-hospital mortality rates between SMuRF-less patients and those with SMuRFs, and established stepped mixed effect models on in-hospital mortality, to explore the potential contributors to different mortality risks (if exist). Results: Among 16541 patients included (aged 65±13 years, 30.0% women), 3288 (19.9%) were SMuRF-less. Compared with patients with SMuRFs, SMuRF-less patients were older (69 vs 65 years, p<0.001), and presented with more severe clinical conditions (mini-Global Registry of Acute Coronary Events risk score; 151 vs 138, p<0.001). SMuRF-less patients were less likely to receive primary percutaneous coronary intervention (17.3% vs 28.8%, p<0.001), as well as dual antiplatelet therapy (59.4% vs 77.0%, p<0.001), β-blocker (78.3% vs 85.7%, p<0.001), angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (49.9% vs 68.1%, p<0.001), statin (69.9% vs 85.1%, p<0.001). Meanwhile, SMuRF-less patients had higher in-hospital mortality (18.5% vs 10.5%, p<0.001). Such difference was largely attenuated after adjusting for baseline characteristics (OR 1.45; 95%CI 1.29-1.64), while disappeared after additionally adjusting for in-hospital treatments (OR 1.04; 95%CI 0.91-1.19), particularly angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and statin. Conclusion: For the one-fifth patients with STEMI who had no SMuRFs the excess in-hospital mortality was associated with their relatively suboptimal treatments, highlighting the need for evidence-based therapy in SMuRF-less patients during hospitalization.