The Korean journal of internal medicine

  • 제34권5호
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  • Pages.1040-1049
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  • 2019
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  • 1226-3303(pISSN)
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  • 2005-6648(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
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Clinical characteristics and outcomes in acute myocardial infarction patients with versus without any cardiovascular risk factors

  • Choi, Ah-Ra (The Heart Center of Chonnam National University Hospital) ;
  • Jeong, Myung Ho (The Heart Center of Chonnam National University Hospital) ;
  • Hong, Young Joon (The Heart Center of Chonnam National University Hospital) ;
  • Sohn, Seok-Joon (Department of Preventive Medicine, Chonnam National University Medical School) ;
  • Kook, Hyun Yi (The Heart Center of Chonnam National University Hospital) ;
  • Sim, Doo Sun (The Heart Center of Chonnam National University Hospital) ;
  • Ahn, Young Keun (The Heart Center of Chonnam National University Hospital) ;
  • Lee, Ki Hong (The Heart Center of Chonnam National University Hospital) ;
  • Cho, Jae Yeong (The Heart Center of Chonnam National University Hospital) ;
  • Kim, Young Jo (Department of Cardiology, Yeungnam University Medical Center) ;
  • Cho, Myeong Chan (Department of Cardiology, Chungbuk National University Hospital) ;
  • Kim, Chong Jin (Department of Cardiology, Kyung Hee University Hospital)
  • 투고 : 2018.02.09
  • 심사 : 2018.04.12
  • 발행 : 2019.09.01
⟨ 이전 논문 다음 논문 ⟩

초록

Background/Aims: Although cardiovascular (CV) risk factors are well established, some patients experience acute myocardial infarction (AMI) even without any risk factors. Methods: We analyzed total 11,390 patients (63.6 ± 12.6 years old, 8,401 males) with AMI enrolled in Korea Acute Myocardial Infarction Registry-National Institute of Health from November, 2011 to December, 2015. Patients were divided into two groups according to the presence of any CV risk factors (group I, without risk factors, n = 1,420 [12.5%]; group II, with risk factors, n = 9,970 [87.5%]). In-hospital outcomes were defined as in-hospital mortality and complications. One-year clinical outcomes were defined as the composite of major adverse cardiac events (MACE). Results: Group I was older (67.3 ± 11.6 years old vs. 63.0 ± 12.7 years old, p < 0.001) and had higher prevalence of female gender (36.2% vs. 24.8%, p < 0.001) than the group II. Group I experienced less previous history of angina pectoris (7.0% vs. 9.4%, p = 0.003) and the previous history of cerebrovascular accidents (3.4% vs. 6.9%, p < 0.001). In-hospital mortality (2.6% vs. 3.0%, p = 0.450) and complications (20.6% vs. 20.0%, p = 0.647) were no differences between the groups. And 1 year clinical outcomes (5.7% vs. 5.1%, p = 0.337) were no differences between the groups. In multivariate logistic regression analysis, serum creatinine level (hazard ratio, 1.35; 95% confidence interval, 1.05 to 1.75; p = 0.021) were independent predictors of 1 year MACE in patients without any CV risk factors. Conclusions: Elderly female patients were prone to develop AMI even without any modifiable CV risk factors. We suggest that more intensive care is needed in AMI patients without any CV risk factors who have high serum creatinine levels.

키워드

과제정보

The authors thank all of the clinical investigators who contributed time and effort to this study, Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH) Investigators. The KAMIR-NIH was supported by a fund (2016-ER6304-01) from Research of Korea Centers for Disease Control and Prevention, Republic of Korea.

참고문헌

  1. Kim JH, Chae SC, Oh DJ, et al. Multicenter cohort study of acute myocardial infarction in Korea: interim analysis of the Korea Acute Myocardial Infarction Registry-National Institutes of Health Registry. Circ J 2016;80:1427-1436. https://doi.org/10.1253/circj.CJ-16-0061
  2. Hubacek JA, Stanek V, Gebauerova M, et al. Traditional risk factors of acute coronary syndrome in four different male populations: total cholesterol value does not seem to be relevant risk factor. Physiol Res 2017;66(Supplementum 1):S121-S128.
  3. Mohammadnezhad M, Mangum T, May W, Lucas JJ, Ailson S. Common modifiable and non-modifiable risk factors of cardiovascular disease (CVD) among Pacific countries. World J Cardiovasc Surg 2016;6:153-170. https://doi.org/10.4236/wjcs.2016.611022
  4. Canto JG, Kiefe CI, Rogers WJ, et al. Atherosclerotic risk factors and their association with hospital mortality among patients with first myocardial infarction (from the National Registry of Myocardial Infarction). Am J Cardiol 2012;110:1256-1261. https://doi.org/10.1016/j.amjcard.2012.06.025
  5. Anand SS, Islam S, Rosengren A, et al. Risk factors for myocardial infarction in women and men: insights from the INTERHEART study. Eur Heart J 2008;29:932-940. https://doi.org/10.1093/eurheartj/ehn018
  6. Hata J, Nagai A, Hirata M, et al. Risk prediction models for mortality in patients with cardiovascular disease: the BioBank Japan project. J Epidemiol 2017;27:S71-S76. https://doi.org/10.1016/j.je.2016.10.007
  7. Torpy JM, Burke AE, Glass RM. JAMA patient page. Coronary heart disease risk factors. JAMA 2009;302:2388. https://doi.org/10.1001/jama.302.21.2388
  8. Kim HK, Jeong MH, Ahn Y, et al. Hospital discharge risk score system for the assessment of clinical outcomes in patients with acute myocardial infarction (Korea Acute Myocardial Infarction Registry [KAMIR] score). Am J Cardiol 2011;107:965-971. https://doi.org/10.1016/j.amjcard.2010.11.018
  9. Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Eur Heart J 2012;33:2551-2567. https://doi.org/10.1093/eurheartj/ehs184
  10. Khot UN, Khot MB, Bajzer CT, et al. Prevalence of conventional risk factors in patients with coronary heart disease. JAMA 2003;290:898-904. https://doi.org/10.1001/jama.290.7.898
  11. Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004;364:937-952. https://doi.org/10.1016/S0140-6736(04)17018-9
  12. Greenland P, Knoll MD, Stamler J, et al. Major risk factors as antecedents of fatal and nonfatal coronary heart disease events. JAMA 2003;290:891-897. https://doi.org/10.1001/jama.290.7.891
  13. Roe MT, Halabi AR, Mehta RH, et al. Documented traditional cardiovascular risk factors and mortality in nonST-segment elevation myocardial infarction. Am Heart J 2007;153:507-514. https://doi.org/10.1016/j.ahj.2006.12.018
  14. Canto JG, Kiefe CI, Rogers WJ, et al. Number of coronary heart disease risk factors and mortality in patients with first myocardial infarction. JAMA 2011;306:2120-2127.
  15. Stamler J, Stamler R, Neaton JD, et al. Low risk-factor profile and long-term cardiovascular and noncardiovascular mortality and life expectancy: findings for 5 large cohorts of young adult and middle-aged men and women. JAMA 1999;282:2012-2018. https://doi.org/10.1001/jama.282.21.2012
  16. Aronow WS, Herzig AH, Etienne F, D'Alba P, Ronquillo J. 41-Month follow-up of risk factors correlated with new coronary events in 708 elderly patients. J Am Geriatr Soc 1989;37:501-506. https://doi.org/10.1111/j.1532-5415.1989.tb05679.x
  17. Rosa SA, Timoteo AT, Nogueira MA, Belo A, Ferreira RC. Risk factor paradox in the occurrence of cardiac arrest in acute coronary syndrome patients. Rev Bras Ter Intensiva 2016;28:405-412.
  18. Ford ES, Ajani UA, Croft JB, et al. Explaining the decrease in U.S. deaths from coronary disease, 1980-2000. N Engl J Med 2007;356:2388-2398. https://doi.org/10.1056/NEJMsa053935
  19. Leifheit-Limson EC, Spertus JA, Reid KJ, et al. Prevalence of traditional cardiac risk factors and secondary prevention among patients hospitalized for acute myocardial infarction (AMI): variation by age, sex, and race. J Womens Health (Larchmt) 2013;22:659-666. https://doi.org/10.1089/jwh.2012.3962
  20. Peterson ED, Bynum DZ, Roe MT. Association of evidence-based care processes and outcomes among patients with acute coronary syndromes: performance matters. J Cardiovasc Nurs 2008;23:50-55. https://doi.org/10.1097/01.JCN.0000305058.03872.f1
  21. Ibanez B, James S, Agewall S, et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018;39:119-177. https://doi.org/10.1093/eurheartj/ehx393
  22. Marenzi G, Assanelli E, Bartorelli AL. Management of acute coronary syndromes in patients with renal insufficiency. Curr Cardiol Rev 2006;2:11-16.