Abstract
Objective: Few studies have been concerned with the combined influences of the presence of multiple risk factors on follow-up outcomes in AMI patients. Our study aimed to identify risk factor patterns that may be associated with 1-year survival in male patients with ST-segment elevation myocardial infarction (STEMI).Methods: Data were from the China STEMI Care Project Phase 2 (CSCAP-2) collected between 2015 and 2018. A total of 15,675 male STEMI patients were enrolled in this study. Risk factor patterns were characterized using latent class analysis (LCA) according to seven risk factors. Associations between risk factor patterns and follow-up outcomes, including the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) and all-cause death, were investigated by Cox proportional hazard regression analysis.Results: We obtained four risk factor patterns as “young and middle-aged with low levels of multimorbidity,” “middle-aged with overweight,” “middle-aged and elderly with normal weight,” and “elderly with high multimorbidity.” Four patterns had significant differences in event-free survival (P < 0.001). As compared with the patients of “young and middle-aged with low levels of multimorbidity” pattern, the risk of incidence of MACCE and all-cause death were increased in patients of “middle-aged with overweight” pattern (All-cause death: HR = 1.70, 95% CI:1.29~2.23; MACCE: HR = 1.49, 95% CI:1.29~1.72), “middle-aged and elderly with normal weight” pattern (All-cause death: HR = 3.04, 95% CI: 2.33~3.98; MACCE: HR = 1.82, 95% CI: 1.56~2.12), and “elderly with high multimorbidity” pattern (All-cause death: HR = 5.78, 95% CI: 4.49~7.42; MACCE: HR = 2.67, 95% CI: 2.31~3.10).Conclusions: By adopting a Latent Class Analysis Approach, STEMI patients can be characterized into four risk factor patterns with significantly different prognosis. The data is useful for the improvement of community health management in each specific subgroup of patients, which indicates a particular risk factor pattern.
Highlights
Acute myocardial infarction (AMI) has high morbidity and acute onset and is one of the leading death causes among cardiovascular diseases
In this study, based on a national healthcare improvement project, we explored the association between risk factor patterns and follow-up outcomes of ST-segment elevation myocardial infarction (STEMI) that is the main type of AMI, with a latent class analysis (LCA) approach
Because that there’s a sex difference among risk factors of a STEMI prognosis, we focused on the male participants in our study because of the limited female population included in the cohort
Summary
Acute myocardial infarction (AMI) has high morbidity and acute onset and is one of the leading death causes among cardiovascular diseases. Numerous studies have shown that risk factors, including aging and obesity smoking, will further increase the mortality of AMI patients [3,4,5]. One study displayed that every additional year of age for AMI patients will lead to an increased risk of 9.3%, with a higher rate of death [6]. Co-morbidities such as diabetes [9, 10], hypertension [5, 11,12,13], cerebrovascular disease [14], and chronic renal failure [3, 4] have an independent association with increased mortality in AMI patients. Few studies were concentrated on the combined influences of the presence of multiple risk factors and outcomes of AMI patients. Insights into the impact of risk factors patterns on the prognosis of AMI patients may help further define and target the therapeutic strategies to specific groups of patients in an attempt to reduce premature death
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