Moledina, S, Rashid, M ORCID: https://orcid.org/0000-0001-9725-1583, Nolan, J ORCID: https://orcid.org/0000-0001-6442-496X, Nakao, K, Sun, L, Velagapudi, P, Wilton, S, Santos Volgman, A, Gale, C and Mamas, MA ORCID: https://orcid.org/0000-0001-9241-8890 (2021) Addressing disparities of care in non-ST-segment elevation myocardial infarction (NSTEMI) patients without standard modifiable risk factors: insights from a nationwide cohort study. European Journal of Preventive Cardiology. (In Press)

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SMURF paper SMM_ACCEPT FINAL_SM.docx - Accepted Version
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Abstract

Background: The importance of standard modifiable cardiovascular risk factors (SMuRFs) in preventing non-ST segment myocardial infarction (NSTEMI) is established. However, NSTEMI may present in the absence of SMuRFs, and little is known about their outcomes.
Methods & Results: We analysed 176,083 adult (≥18 years) hospitalisations with NSTEMI using data from the United Kingdom (UK) Myocardial Infarction National Audit Project (MINAP). Clinical characteristics and all-cause in-hospital mortality were analysed according to SMuRF status, with 135,223 patients presenting with at least one of diabetes, hypertension, hypercholesterolemia or current smoking status and 40,860 patients without any SMuRFs. Those with a history of coronary artery disease were excluded. Patients without SMuRFs were more frequently older (median age 72 year vs. 71 years, P<0.001), male (62% vs. 61%, P<0.001) and Caucasian (95% vs. 92%, P<0.001). Those without SMuRFs less frequently received statins (71% vs. 81%, P<0.001), had their left ventricular function recorded (62% vs. 65%, P<0.001) or for those with moderate or severe left ventricular systolic dysfunction were prescribed angiotensin converting enzyme inhibitors/angiotensin receptor blockers (80% vs. 85%, P<0.001). Following propensity score matching the odds of all-cause mortality (OR: 0.85, 95% CI: 0.77-0.93), cardiac mortality (OR: 0.85, 95% CI: 0.76-0.94) and MACE (OR: 0.85, 95% CI: 0.77-0.93) were lower in patients without SMuRFs.
Conclusion: More than one in five patients presenting with NSTEMI had no SMuRFs, who were less frequently received guideline recommended management and had lower in-hospital (all-cause and cardiac) mortality and MACE than patients with SMuRFs.

Item Type: Article
Additional Information: The final version of this article and all relevant information related to it, including copyrights, can be found on the publisher website.
Subjects: R Medicine > R Medicine (General)
R Medicine > R Medicine (General) > R735 Medical education. Medical schools. Research
R Medicine > RA Public aspects of medicine
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
R Medicine > RC Internal medicine > RC666 Diseases of the circulatory (Cardiovascular) system
Divisions: Faculty of Medicine and Health Sciences > School of Medicine
Depositing User: Symplectic
Date Deposited: 10 Nov 2021 11:08
Last Modified: 10 Nov 2021 11:08
URI: https://eprints.keele.ac.uk/id/eprint/10261

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