Characteristics and Outcome in Acute Coronary Syndrome Patients with and without Established Modifiable Cardiovascular Risk Factors: Insights from the Nationwide AMIS Plus Registry 1997–2010

Abstract

Objectives: Little is known about patients without known modifiable risk factors presenting initially with acute coronary syndrome (ACS). This study assessed baseline characteristics and outcomes of ACS patients with and without the known modifiable risk factors arterial hypertension, dyslipidemia, obesity, smoking or diabetes. Methods: All ACS patients enrolled in the AMIS Plus Registry between 1997 and 2010 were analyzed until hospital discharge; a subgroup was re-assessed at the 1-year follow-up. Outcome measures were in-hospital mortality and major adverse cardiac or cerebrovascular events (MACCE) defined as a composite outcome of mortality, re-infarction and cerebrovascular events. Results: Of 33,306 patients, 2,125 (6.4%) had none of these modifiable risk factors. They were older (males), had less moderate or severe comorbidities and were more frequently in Killip class I on admission. Treatment of ACS patients with or without modifiable risk factors was similar with regard to interventional therapies and use of antiplatelet agents. In-hospital mortality was lower in patients without modifiable risk factors but in-hospital MACCE and 1-year survival was similar. Conclusion: Lack of modifiable risk factors was an independent predictor of lower in-hospital mortality but not of MACCE in patients who presented with ACS.

Cedera Hati Hipoksik Prediktor Komplikasi Akut Utama Pasien Infark Miokard di Unit Rawat Intensif Koroner Rumah Sakit Cipto Mangunkusumo

“…Angka kejadian MACE pada SKA selama perawatan di rumah sakit adalah 12,1%. 5 Berbagai penanda biologis kimiawi (biomarker) dikembangkan untuk memprediksi risiko MACE dan mortalitas SKA. Tantangannya adalah mendapatkan biomarker yang akurat, mudah dilakukan, dan costeffective.…”

Inflammation of the periodontium associates with risk of future cardiovascular events

“…Nevertheless, >40% of all heart attacks and strokes occur in patients with "normal" cholesterol levels. 33 In humans, plaques at high-risk for rupture present distinct features, including intense inflammation and oxidative stress, large areas of necrosis composed of apoptotic cells with thinning, and inflammation of the protective fibrous cap. 34,35 There are significant data to suggest that local inflammatory foci, particularly in the oral cavity, 14,36,37 can impact the systemic inflammatory burden 38,39 and may contribute to the risk for MACE.…”

“…Established risk factors, including dyslipidemia, hypertension, diabetes mellitus, and smoking are associated with MACE. Nevertheless, >40% of all heart attacks and strokes occur in patients with "normal" cholesterol levels 33 . In humans, plaques at high‐risk for rupture present distinct features, including intense inflammation and oxidative stress, large areas of necrosis composed of apoptotic cells with thinning, and inflammation of the protective fibrous cap 34,35 .…”

Simultaneous Left Ventricular Pseudo-Aneurysm and Ventricular Septal Rupture After a Non-ST Segment Myocardial Infarction

“…Acute coronary syndrome (ACS) accounted directly or indirectly for 25% of all deaths in the United States in the last decade [9]. Myocardial rupture occurs in 4% of the cases as a complication from several types of injuries, more often, myocardial infarction (MI) [1].…”