Risk factor paradox in the occurrence of cardiac arrest in acute coronary syndrome patients

Abstract

ObjectiveTo compare patients without previously diagnosed cardiovascular risk factors) and patients with one or more risk factors admitted with acute coronary syndrome.MethodsThis was a retrospective analysis of patients admitted with first episode of acute coronary syndrome without previous heart disease, who were included in a national acute coronary syndrome registry. The patients were divided according to the number of risk factors, as follows: 0 risk factor (G0), 1 or 2 risk factors (G1 - 2) and 3 or more risk factors (G ≥ 3). Comparative analysis was performed between the three groups, and independent predictors of cardiac arrest and death were studied.ResultsA total of 5,518 patients were studied, of which 72.2% were male and the mean age was 64 ± 14 years. G0 had a greater incidence of ST-segment elevation myocardial infarction, with the left anterior descending artery being the most frequently involved vessel, and a lower prevalence of multivessel disease. Even though G0 had a lower Killip class (96% in Killip I; p < 0.001) and higher ejection fraction (G0 56 ± 10% versus G1 - 2 and G ≥ 3 53 ± 12%; p = 0.024) on admission, there was a significant higher incidence of cardiac arrest. Multivariate analysis identified the absence of risk factors as an independent predictor of cardiac arrest (OR 2.78; p = 0.019). Hospital mortality was slightly higher in G0, although this difference was not significant. By Cox regression analysis, the number of risk factors was found not to be associated with mortality. Predictors of death at 1 year follow up included age (OR 1.05; p < 0.001), ST-segment elevation myocardial infarction (OR 1.94; p = 0.003) and ejection fraction < 50% (OR 2.34; p < 0.001).ConclusionEven though the group without risk factors was composed of younger patients with fewer comorbidities, better left ventricular function and less extensive coronary disease, the absence of risk factors was an independent predictor of cardiac arrest.

Clinical characteristics and outcomes in acute myocardial infarction patients with versus without any cardiovascular risk factors

“…In-hospital mortality and complications were showed little higher trend in patients with risk factors, but there was not statistical significance. This finding is consistent with the previous studies [13,14,17]. Canto et al [14] reported that among patients with incident AMI without prior CV, in-hospital mortality was inversely related to the number of coronary heart disease risk factors.…”

Cardiac arrest as an age-dependent prognosticator for long-term mortality after acute myocardial infarction: the potential impact of infarction size

“…Rosa et al 9 recently investigated the impact of pre-existing comorbidities and conventional risk factors on the outcome of patients admitted with their first episode of AMI. 23,24 The authors found that the absence of any established cardiovascular risk factor was independently associated with the development of CA.…”

“…7,8 In this regard, recently reported data demonstrated that especially young patients presenting with fewer cardiovascular comorbidities are at higher risk of CA in the acute phase of AMI, which indeed underlines a strong need to elucidate the prognostic relevance of CA from an age-specific perspective. 9 While the impact of CA on both mortality and neurological outcomes poses a well investigated field during the past decades, there is lack of evidence on its age-specific prognostic impact independently from an AMI perspective. 10 However, suitable age-specific secondary prevention and risk-stratification seems of utmost importance, especially in premature AMI individuals, rather losing decades of life expectancy than years.…”

“…7,8 In this regard, recently reported data demonstrated that especially young patients presenting with fewer cardiovascular comorbidities are at higher risk of CA in the acute phase of AMI, which indeed underlines a strong need to elucidate the prognostic relevance of CA from an age-specific perspective. 9…”