Ethnic disparities in ST-segment myocardial infarction outcomes and processes of care in patients with and without standard modifiable cardiovascular risk factors: a nationwide cohort study

Abstract

Background There is growing interest in patients presenting with ST-elevation myocardial infarction (STEMI) in the absence of `standard modifiable cardiovascular risk factors' (SMuRFs), which include current smoking, hypertension, diabetes and hypercholesterolaemia. Recent trials have demonstrated how these “SMuRFless” patients can have poorer outcomes after STEMI then those patients with SMuRFs, but these trials have not looked at the role of ethnicity in outcomes (1). Methods We analysed 118,177 STEMI patients using the Myocardial Infarction National Audit Project (MINAP) registry. Clinical characteristics and outcomes were analysed using hierarchical logistic regression models according to the presence of =1 SMuRF (88,055) and compared to the “SMuRFless” cohort (30,122), with a subgroup analysis comparing the outcomes of white and ethnic minority patients (comprising Black, Asian, Mixed and other) depending on SMuRF status. Our primary outcomes were in-hospital mortality and major adverse cardiovascular events (MACE), and secondary outcomes were in-hospital cardiac mortality and major bleeding. Results SMuRFless patients had a higher incidence of MACE (OR 1.09, CI 1.02–1.16), in-hospital mortality (OR 1.09, CI 1.01–1.18), and cardiac-mortality (OR 1.08, CI 1.00–1.17) than those with SMuRFs after adjusting for baseline demographics, haemodynamic status, killip classification, cardiac arrest, and common comorbidities. There were no statistically significant differences in our outcome measures between white and ethnic minority patients. Ethnic minority patients were more likely to undergo revascularisation by PCI or CABG (ethnic minority with SMuRFs 88%, ethnic minority SMuRFless 87%, white with SMuRFs 80%, white SMuRFless 77%). Conclusion SMuRFless patients have a higher incidence of MACE, in-hospital mortality, and cardiac-mortality than those with SMuRFs, which persists after adjusting for baseline demographics, haemodynamic status, killip classification, cardiac arrest, and common comorbidities. Ethnic minority patients were more likely undergo ICA and revascularisation regardless of SMuRF status but did not have poorer outcomes when compared to white patients. Funding Acknowledgement Type of funding sources: None.