Aim Modifiable cardiovascular risk factors (RFs) play a key role in the development of coronary artery disease. We evaluated 20-year trends in RF prevalence among young adults hospitalised with acute coronary syndromes (ACS) in Switzerland. Methods and results Data were analysed from the Acute Myocardial Infarction in Switzerland (AMIS) Plus registry from 2000 to 2019. Young patients were defined as those aged <50 years. Among 58’028 ACS admissions, 7’073 (14.1%) were young (median 45.6 years, IQR 42.0-48.0), of which 91.6% had at least one modifiable RF, and 59.0% had at least two RFs. Smoking was the most prevalent RF (71.4%), followed by dyslipidaemia (57.3%), hypertension (35.9%), obesity (21.7%) and diabetes (10.1%). Compared with older patients, young patients were more likely to be obese (21.7% vs 17.4%, p < 0.001) and active smokers (71.4% vs 33.9%, p < 0.001). Among young patients, between 2000 and 2019 there was a significant increase in the prevalence of hypertension from 29.0% to 51.3% and obesity from 21.2% to 27.1% (both ptrend < 0.001), but a significant decrease in active smoking from 72.5% to 62.5% (ptrend = 0.02). There were no significant changes in the prevalence of diabetes (ptrend = 0.32) or dyslipidaemia (ptrend = 0.067). Conclusion Young ACS patients in Switzerland exhibit a high prevalence of RFs, and are more likely than older patients to be obese and smokers. Between 2000 and 2019, RF prevalence either increased or remained stable, except for smoking which decreased but still affected ∼2/3 of young patients in 2019. Public health initiatives targeting RFs in young adults in Switzerland are warranted.
Introduction Risk prediction scores adopted in acute coronary syndromes use incremental models to estimate mortality for heart rate (HR) above 60 bpm. Nonetheless, a non-linear, bimodal relationship, with higher event rates at low or high HR, has been described, potentially hampering risk prediction accuracy. Purpose Our aim was to assess the prognostic impact of bradycardia, defined as admission HR <50 bpm, in myocardial infarction (MI) among patients enrolled in a large nationwide registry. Methods Data of patients enrolled between 1999 and 2021 stratified by admission HR were retrospectively analysed. The primary endpoint was in-hospital mortality. The secondary endpoint was a composite of death, cerebrovascular event, and reinfarction. Associations between HR and outcomes were assessed at univariate and multivariable logistic regression analyses, then verified after sequential propensity-score matchings among HR groups. Results 51001 patients (median age 66 years, IQR 56–76) were included. Crude estimates showed a bimodal distribution of primary and secondary endpoints with peaks at low and high HR. Association of HR <50 bpm with mortality was recognised only at primary multivariable logistic regression analysis (OR 1.49; 95% CI 1.01–2.13 p=0.038) but not at multiple sensitivity analyses after exclusion of patients on negative chronotropic therapy. Three sequential propensity-score matching were performed among patients with HR <50 bpm at admission and those with HR 50–75 bpm, HR 76–100 bpm and HR >100 bpm at admission, identifying 1159, 1159 and 1158 matched pairs, respectively. After propensity-score matching, rates of primary and secondary endpoints equalled among groups with HR <100 bpm. Conclusions Bradycardia (HR <50 bpm) at admission in patients with MI identified a group with higher crude rate of adverse events. Nonetheless, the signal supporting an independent association between bradycardia at admission and short-term mortality is weak and was not confirmed after correction for relevant baseline differences by propensity score matching. These findings support the hypothesis that lower HR might not be causative for the worse outcomes, but rather serves as a marker of underlying morbidity. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): The AMIS Plus registry is funded by unrestricted grants from the Swiss Heart Foundation and from Abbot AG, Amgen AG, AstraZeneca AG, Bayer (Schweiz) AG, Biotronik AG, Boston Scientific AG, B. Braun Medical AG, Daiichi-Sankyo/Lilly AG, Cordis Cardinal Health GmbH, Medtronic AG, Novartis Pharma Schweiz AG, Sanofi-Aventis (Schweiz) AG, SIS Medical AG, Terumo AG, Vascular Medical GmbH, all in Switzerland, and the Swiss Working Group for Interventional Cardiology. The sponsors did not play any role in the design, data collection, analysis, or interpretation of data.
Introduction This study aimed to analyse changes in prehospital delay over time in women and men presenting with ST-elevation myocardial infarction (STEMI) in Switzerland. Methods AMIS Plus registry data of patients admitted for STEMI between 2002 and 2019 was analysed using multivariable quantile regression including the following covariates: interaction between sex and admission year, age, diabetes, pain at presentation, myocardial infarction (MI) history, heart failure history, hypertension and renal disease. Results Among the 15,350 patients included (74.5% men), the median (IQR) delay between 2002 and 2019 was 150 (84; 345) minutes for men and 180 (100; 414) minutes for women. The unadjusted median prehospital delay significantly decreased over time for both sexes but the decreasing trend was stronger for women. Specifically, the unadjusted sex differences in delay decreased from 60 minutes in 2002 (p = 0.0042) to 40.5 minutes in 2019 (p = 0.165). The multivariable model revealed a significant interaction between sex and admission year (p = 0.038) indicating that the decrease in delay was stronger for women (-3.3 minutes per year) than for men (-1.6 minutes per year) even after adjustment. The adjusted difference between men and women decreased from 26.9 minutes in 2002 to -1.97 minutes for women in 2019. Conclusions Over two decades, delay between symptom onset and hospital admission in STEMI decreased significantly for men and women. The decline was more pronounced in women, leading to the sex gap disappearing in the adjusted analysis for 2019.
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