TY - JOUR
T1 - Ethnic Disparities in ST-Segment Elevation Myocardial Infarction Outcomes and Processes of Care in Patients With and Without Standard Modifiable Cardiovascular Risk Factors
T2 - A Nationwide Cohort Study
AU - Weight, Nicholas
AU - Moledina, Saadiq
AU - Sun, Louise
AU - Kragholm, Kristian
AU - Freeman, Phillip
AU - Diaz-Arocutipa, Carlos
AU - Dafaalla, Mohamed
AU - Gulati, Martha
AU - Mamas, Mamas A.
N1 - Publisher Copyright:
© The Author(s) 2023.
PY - 2023
Y1 - 2023
N2 - Trials suggest patients with ST-elevation myocardial infarction (STEMI) without ‘standard modifiable cardiovascular risk factors’ (SMuRFs) have poorer outcomes, but the role of ethnicity has not been investigated. We analyzed 118,177 STEMI patients using the Myocardial Ischaemia National Audit Project (MINAP) registry. Clinical characteristics and outcomes were analyzed using hierarchical logistic regression models; patients with ≥1 SMuRF (n = 88,055) were compared with ‘SMuRFless’ patients (n = 30,122), with subgroup analysis comparing outcomes of White and Ethnic minority patients. SMuRFless patients had higher incidence of major adverse cardiovascular events (MACE) (odds ratio, OR: 1.09, 95% CI 1.02–1.16) and in-hospital mortality (OR: 1.09, 95% CI 1.01–1.18) after adjusting for demographics, Killip classification, cardiac arrest, and comorbidities. When additionally adjusting for invasive coronary angiography (ICA) and revascularisation (percutaneous coronary intervention (PCI) or coronary artery bypass grafts surgery (CABG)), results for in-hospital mortality were no longer significant (OR 1.05, 95% CI.97–1.13). There were no significant differences in outcomes according to ethnicity. Ethnic minority patients were more likely to undergo revascularisation with ≥1 SMuRF (88 vs 80%, P <.001) or SMuRFless (87 vs 77%, P <.001. Ethnic minority patients were more likely undergo ICA and revascularisation regardless of SMuRF status.
AB - Trials suggest patients with ST-elevation myocardial infarction (STEMI) without ‘standard modifiable cardiovascular risk factors’ (SMuRFs) have poorer outcomes, but the role of ethnicity has not been investigated. We analyzed 118,177 STEMI patients using the Myocardial Ischaemia National Audit Project (MINAP) registry. Clinical characteristics and outcomes were analyzed using hierarchical logistic regression models; patients with ≥1 SMuRF (n = 88,055) were compared with ‘SMuRFless’ patients (n = 30,122), with subgroup analysis comparing outcomes of White and Ethnic minority patients. SMuRFless patients had higher incidence of major adverse cardiovascular events (MACE) (odds ratio, OR: 1.09, 95% CI 1.02–1.16) and in-hospital mortality (OR: 1.09, 95% CI 1.01–1.18) after adjusting for demographics, Killip classification, cardiac arrest, and comorbidities. When additionally adjusting for invasive coronary angiography (ICA) and revascularisation (percutaneous coronary intervention (PCI) or coronary artery bypass grafts surgery (CABG)), results for in-hospital mortality were no longer significant (OR 1.05, 95% CI.97–1.13). There were no significant differences in outcomes according to ethnicity. Ethnic minority patients were more likely to undergo revascularisation with ≥1 SMuRF (88 vs 80%, P <.001) or SMuRFless (87 vs 77%, P <.001. Ethnic minority patients were more likely undergo ICA and revascularisation regardless of SMuRF status.
KW - STEMI
KW - diabetes mellitus
KW - ethnicity
KW - hypercholesterolemia
KW - smoking and hypertension
UR - http://www.scopus.com/inward/record.url?scp=85162717145&partnerID=8YFLogxK
U2 - 10.1177/00033197231182555
DO - 10.1177/00033197231182555
M3 - Artículo
C2 - 37306087
AN - SCOPUS:85162717145
SN - 0003-3197
JO - Angiology
JF - Angiology
ER -