Naslov
Patients presenting with acute myocardial infarction and no apparent cardiovascular risk factors: are they wolves in sheep’s clothing?

Autori
Mikačić, Marijana ; Glavaš, Duška ; Borovac, Josip Anđelo

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, prošireni sažetak, ostalo

Skup
14. kongres Hrvatskoga kardiološkog društva ; 9. kongres Hrvatske udruge kardioloških medicinskih sestara = 14th Congress of the Croatian Cardiac Society ; 9th Congress of the Croatian Association of Cardiology Nurses

Mjesto i datum
Zagreb, Hrvatska, 24.11.2022. - 27.11.2022

Vrsta sudjelovanja
Predavanje

Vrsta recenzije
Domaća recenzija

Ključne riječi
acute myocardial infarction ; AMI ; characteristics ; risk factors ; standard modifiable risk factors ; SMuRF ; SMuRFs ; outcomes ; in-hospital ; STEMI ; NSTEMI

Sažetak
GOAL: Recent studies showed that patients without standard modifiable cardiovascular risk factors (CVRFs) suffering an acute myocardial infarction (AMI) might have worse outcomes and prognoses than patients with established CVRFs (1). The goal of the present study was to determine the proportion and relevant characteristics of patients with no apparent CVRFs who present with AMI at a tertiary-level clinical center. METHODS: We grouped and analyzed a cohort of consecutive patients admitted for AMI to our center during the 2019-2020 period. We examined the presence or absence of apparent CVRFs including smoking, arterial hypertension, diabetes mellitus, history of MI or revascularization, and atrial fibrillation. RESULTS: The proportion of patients with AMI and without apparent CVRFs in our sample was 14.4% (29/202 patients). The rate of composite outcome consisting of in-hospital death and emergent referral to CABG surgery was lower in patients without than with CVRFs (3.4% vs. 8.7%). Both groups had a similar prevalence of multivessel coronary disease (17.2% vs. 23.1%). Furthermore, they were less likely to present with dyspnea or nausea and vomiting, compared to patients with CVRFs (13.8 vs. 27.7% and 17.2 vs. 33.5%, respectively). Notably, both groups did not significantly differ in terms of age (median 67 vs. 65 years), male sex (62.1 vs. 68.8 %), AMI type (STEMI in 66 vs. 58% of cases), hemoglobin (median 139 vs. 141 g/L), renal function (median creatinine of 74 vs. 79 μmol/L), and CRP (median 6.1 vs. 5.0 mg/L). However, patients without apparent CVRFs exhibited a significantly greater degree of myocardial injury as evidenced by higher median hs-cTnI levels, compared to patients with at least one CVRF [1073 (IQR 156-7000) vs. 300 (IQR 65-3551) ng/L, p<0.05] as shown in Figure 1. CONCLUSION: About 14 in 100 patients with AMI in our cohort did not have apparent CVRFs. These patients seem to be less likely to present with dyspnea or nausea and vomiting and do not differ significantly in most of the clinical and laboratory variables to patients with CVRFs. However, these patients had more than a 3-fold greater myocardial injury as measured by circulating troponin levels. Therefore, particular clinical scrutiny should be applied to patients without overt symptoms and a history of CVRFs that present to ED with chest pain.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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