Addressing disparities of care in non-ST-segment elevation myocardial infarction (NSTEMI) patients without standard modifiable risk factors: insights from a nationwide cohort study

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.