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Number of standard modifiable risk factors and mortality in patients with first-presentation ST-segment elevation myocardial infarction: insights from China Acute Myocardial Infarction registry

Dataset

  • Sidong Li (Creator)
  • Xiaojin Gao (Creator)
  • Jingang Yang (Creator)
  • Haiyan Xu (Creator)
  • Yang Wang (Creator)
  • Yanyan Zhao (Creator)
  • Lu Yin (Creator)
  • Chao Wu (Creator)
  • Yi WangUniversity of Electronic Science and Technology of China, Zhongnan Hospital of Wuhan University, Shangrao Normal University, Fudan University, Nanjing Drum Tower Hospital, Wenzhou Medical College, Soochow University, Sichuan Agricultural University, Huazhong University of Science and Technology, Affiliated Hospital of Nantong University, Jilin Agricultural University, Shanghai Tenth People's Hospital, Johns Hopkins University, Shandong University, Chongqing University, Jiangnan University, Zhejiang University, Second Hospital of Anhui Medical University, Zhejiang University, China agricultural University, University of California, Beijing Proteome Research Center, Shanghai University of Traditional Chinese Medicine, National University of Singapore, Tongji University (Creator)
  • Yang Zheng (Creator)
  • Bao Li (Creator)
  • Xuan Zhang (Creator)
  • Yunqing Ye (Creator)
  • Rui Fu (Creator)
  • Qiuting Dong (Creator)
  • Yao-hui Sun (Creator)
  • Xinxin Yan (Creator)
  • Yuan Wu (Creator)
  • Jun Zhang (Creator)
  • Chen Jin (Creator)
  • Wei LiFirst Affiliated Hospital of Zhengzhou University, Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, 410011, China, University of Electronic Science and Technology of China, Central South University, Northeast Agricultural University, Ministry of Education of the People's Republic of China, Academy of Military Medical Science China, International Peace Maternity & Child Health Hospital, Jiangsu Province Hospital, Chinese Academy of Sciences, School of Computer Science, Nanjing University of Information Science and Technology, Nanjing, China, CAS - Institute of Hydrobiology, Chinese Academy of Medical Sciences & Peking Union Medical College, Third Military Medical University, University of Science and Technology of China, Northeast Forestry University, Children's Hospital of Capital Institute of Pediatrics, Northwest Normal University, Nanjing Forestry University, China-Japan Friendship Hospital, Tsinghua University, University of Chinese Academy of Sciences, Second Affiliated Hospital of Soochow University, Guangdong Medical College, Indiana University Purdue University Indianapolis, Peking University Third Hospital, University of California, First Affiliated Hospital of Hebei Medical University, Tongji University, Peking University, First Hospital of Jilin University, National Institute for Communicable Disease Control and Prevention, Jilin University, Shandong University, Shanghai Jiao Tong University, Zhengzhou University, Baylor College of Medicine, Inner Mongolia Agricultural University, Xi'an Jiaotong university, Guangzhou Women and Children Medical Center (Creator)
  • Yuejin Yang (Creator)

Description

Abstract Background Recent publications reported a paradoxical finding that there was an inverse association between the number of standard modifiable risk factors (SMuRFs; smoking, hypertension, diabetes, and hyperlipidemia) and mortality in patients with myocardial infarction. However, the current evidence is only limited to those highly developed countries with advanced medical management systems. Methods The China Acute Myocardial Infarction registry is a prospective observational study including patients with acute myocardial infarction from three-level hospitals across 31 administrative regions throughout mainland China. A total of 16,228 patients with first-presentation ST-elevation myocardial infarction (STEMI) admitted to hospitals from January 2013 to September 2014 were enrolled in the current analysis. Cox proportional hazard models adjusting for baseline characteristics, clinical profiles at presentation, and in-hospital treatments were used to assess the association of the number of SMuRFs with all-cause mortality at 30 days after STEMI presentation. Results A total of 1918 (11.8%), 11,503 (70.9%), and 2807 (17.3%) patients had 0, 1–2, and 3–4 SMuRFs at presentation, respectively. Patients with fewer SMuRFs were older and more likely to be females, experienced longer pre-hospital delays, and were less likely to receive primary percutaneous coronary intervention and evidence-based medications. Compared with those without any SMuRF, patients with 1–2 SMuRFs and 3–4 SMuRFs were associated with an HR of 0.74 (95% CI, 0.63–0.87) and 0.63 (0.51–0.77) for all-cause mortality up to 30 days in the unadjusted model (Ptrend < 0.0001). However, after multivariate adjustment, the number of SMuRFs was positively associated with increased mortality risk (HR for 1–2 SMuRFs, 1.15 [0.95–1.39]; HR for 3–4 SMuRFs, 1.31 [1.02–1.68]; Ptrend = 0.03), and the association was only significant among patients admitted to hospitals beyond 12 h from onset (HR for 1–2 SMuRFs, 1.39 [1.03–1.87]; HR for 3–4 SMuRFs, 2.06 [1.41–3.01]) but not their counterparts (Pinteraction = 0.01). Conclusions The increased crude mortality risk among patients without SMuRFs is explained by confounding factors related to their poor risk profiles (old age, longer pre-hospital delays, and poor clinical management). After multivariate adjustment, a higher risk-factor burden was associated with poor prognosis among patients with STEMI.
Date made available2022
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