Coronary Artery Disease Without Standard Cardiovascular Risk Factors - 31/12/21

Doi : 10.1016/j.amjcard.2021.10.032

Ko Yamamoto, MD ^a, Masahiro Natsuaki, MD ^b, Takeshi Morimoto, MD, MPH ^c, Hiroki Shiomi, MD ^a, Yasuaki Takeji, MD ^a, Kyohei Yamaji, MD ^d, Yukiko Matsumura-Nakano, MD ^a, Yusuke Yoshikawa, MD ^a, Erika Yamamoto, MD ^a, Masayuki Fuki, MD ^a, Eri Kato, MD ^a, Yugo Yamashita, MD ^a, Hidenori Yaku, MD ^e, Kenji Nakatsuma, MD ^e, Hiroki Watanabe, MD ^f, Mitsuo Matsuda, MD ^g, Toshihiro Tamura, MD ^h, Moriaki Inoko, MD ⁱ, Hiroshi Mabuchi, MD ^j, Manabu Shirotani, MD ^k, Hiroshi Eizawa, MD ^l, Katsuhisa Ishii, MD ^m, Tsukasa Inada, MD ⁿ, Tomoya Onodera, MD ^o, Eiji Shinoda, MD ^p, Takashi Yamamoto, MD ^q, Mamoru Toyofuku, MD ^f, Mamoru Takahashi, MD ^r, Hiroki Sakamoto, MD ^s, Shinji Miki, MD ^e, Takeshi Aoyama, MD ^t, Satoru Suwa, MD ^u, Yukihito Sato, MD ^v, Yutaka Furukawa, MD ^w, Kenji Ando, MD ^d, Kazushige Kadota, MD ^x, Yoshihisa Nakagawa, MD ^q, Takeshi Kimura, MD ^a,^⁎
On behalf of the
Credo-Kyoto PCI/CABG Registry Investigators
^a Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
^b Department of Cardiovascular Medicine, Saga University, Saga, Japan
^c Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
^d Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
^e Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
^f Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
^g Department of Cardiology, Kishiwada City Hospital, Kishiwada, Japan
^h Department of Cardiology, Tenri Hospital, Tenri, Japan
ⁱ Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
^j Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan
^k Department of Cardiology, Kindai University Nara Hospital, Ikoma, Japan
^l Department of Cardiology, Kobe City Nishi-Kobe Medical Center, Kobe, Japan
^m Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
ⁿ Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
^o Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
^p Department of Cardiology, Hamamatsu Rosai Hospital, Hamamatsu, Japan
^q Department of Cardiovascular Medicine, Shiga University of Medical Science Hospital, Otsu, Japan
^r Department of Cardiology, Shimabara Hospital, Kyoto, Japan
^s Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
^t Division of Cardiology, Shimada Municipal Hospital, Shimada, Japan
^u Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan
^v Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
^w Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
^x Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan

^⁎Corresponding author: Tel: +81-75-751-4255; fax: +81-75-751-3299.

Résumé

Recently, one observational study showed that patients with ST-segment elevation myocardial infarction (STEMI) without standard cardiovascular risk factors were associated with increased mortality compared with patients with risk factors. This unexpected result should be evaluated in other populations including those with non–ST-segment elevation acute coronary syndrome (NSTE-ACS) and chronic coronary syndrome (CCS). Among 30,098 consecutive patients undergoing first coronary revascularization in the CREDO-Kyoto PCI/CABG (Coronary Revascularization Demonstrating Outcome Study in Kyoto Percutaneous Coronary Intervention/Coronary Artery Bypass Grafting) registry cohort-2 and 3, we compared clinical characteristics and outcomes between patients with and without risk factors stratified by their presentation (STEMI n = 8,312, NSTE-ACS n = 3,386, and CCS n = 18,400). Patients with risk factors were defined as having at least one of the following risk factors: hypertension, dyslipidemia, diabetes, and current smoking. The proportion of patients without risk factors was low (STEMI: 369 patients [4.4%], NSTE-ACS: 110 patients [3.2%], and CCS: 462 patients [2.5%]). Patients without risk factors compared with those with risk factors more often had advanced age, low body weight, and malignancy and less often had history of atherosclerotic disease and prescription of optimal medical therapy. In patients with STEMI, patients without risk factors compared with those with risk factors were more often women and more often had atrial fibrillation, long door-to-balloon time, and severe hemodynamic compromise. During a median of 5.6 years follow-up, patients without risk factors compared with those with risk factors had higher crude incidence of all-cause death. After adjusting confounders, the mortality risk was significant in patients with CCS (hazard ratio [HR] 1.22, 95% confidence interval [CI] 1.01 to 1.49, p = 0.04) but not in patients with STEMI (HR 1.06, 95% CI 0.89 to 1.27, p = 0.52) and NSTE-ACS (HR 1.07, 95% CI, 0.74 to 1.54, p = 0.73). In conclusion, among patients undergoing coronary revascularization, patients without standard cardiovascular risk factors had higher crude incidence of all-cause death compared with those with at least one risk factor. After adjusting confounders, the mortality risk was significant in patients with CCS but not in patients with STEMI and NSTE-ACS.

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This study was supported by an educational grant from the Research Institute for Production Development (Kyoto, Japan) and the Pharmaceuticals and Medical Devices Agency (PMDA) in Japan (Tokyo, Japan).

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Vol 164

P. 34-43 - février 2022 Retour au numéro

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Coronary Artery Disease Without Standard Cardiovascular Risk Factors - 31/12/21

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