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Survival After MI in a Community Cohort Study: Contribution of Comorbidities in NSTEMI.

TitleSurvival After MI in a Community Cohort Study: Contribution of Comorbidities in NSTEMI.
Publication TypeJournal Article
Year of Publication2018
AuthorsForaker RE, Guha A, Chang H, O'Brien EC, Bower JK, Crouser ED, Rosamond WD
Secondary AuthorsRaman SV
JournalGlob Heart
Volume13
Issue1
Pagination13-18
Date Published2018 03
ISSN2211-8179
KeywordsComorbidity, Diabetes Mellitus, Female, Follow-Up Studies, Humans, Hypertension, Incidence, Male, Middle Aged, Non-ST Elevated Myocardial Infarction, Prevalence, Residence Characteristics, Retrospective Studies, Risk Factors, Survival Rate, Time Factors, United States
Abstract

BACKGROUND: Non-ST-segment elevation myocardial infarction (NSTEMI) comprises the majority of MI worldwide, yet mortality remains high. Management of NSTEMI is relatively delayed and heterogeneous compared with the "time is muscle" approach to ST-segment elevation MI, though it is unknown to what extent comorbid conditions drive NSTEMI mortality.

OBJECTIVES: We sought to quantify mortality due to MI versus comorbid conditions in patients with NSTEMI.

METHODS: Participants of the ARIC (Atherosclerosis Risk in Communities) study cohort ages 45 to 64 years, who developed incident NSTEMI were identified and incidence-density matched to participants who did not experience an MI by age group, sex, race, and study community. We estimated hazard ratios for all-cause mortality, comparing those who developed NSTEMI to those who did not experience an MI.

RESULTS: ARIC participants with incident NSTEMI were more likely at baseline to be smokers, have diabetes and renal dysfunction, and take blood pressure or cholesterol-lowering medications than were participants who did not have an MI. Over one-half of participants experiencing NSTEMI died over a median follow-up of 8.4 years; incident NSTEMI was associated with 30% higher risk of mortality after adjusting for comorbid conditions (hazard ratio: 1.30; 95% confidence interval: 1.11 to 1.53).

CONCLUSIONS: NSTEMI confers a significantly higher mortality hazard beyond what can be attributed to comorbid conditions. More consistent and effective strategies are needed to reduce mortality in NSTEMI amid comorbid conditions.

DOI10.1016/j.gheart.2018.01.002
Alternate JournalGlob Heart
PubMed ID29409724
PubMed Central IDPMC5963709
Grant ListHHSN268201100012C / HL / NHLBI NIH HHS / United States
HHSN268201100010C / HL / NHLBI NIH HHS / United States
HHSN268201100008C / HL / NHLBI NIH HHS / United States
HHSN268201100007C / HL / NHLBI NIH HHS / United States
HHSN268201100011I / HL / NHLBI NIH HHS / United States
HHSN268201100011C / HL / NHLBI NIH HHS / United States
HHSN268201000011C / HL / NHLBI NIH HHS / United States
HHSN268201100006C / HL / NHLBI NIH HHS / United States
R01 HL116533 / HL / NHLBI NIH HHS / United States
HHSN268201100005I / HL / NHLBI NIH HHS / United States
HHSN268201100009I / HL / NHLBI NIH HHS / United States
HHSN268201000012C / HL / NHLBI NIH HHS / United States
HHSN268201100005G / HL / NHLBI NIH HHS / United States
HHSN268201100008I / HL / NHLBI NIH HHS / United States
HHSN268201100009C / HL / NHLBI NIH HHS / United States
HHSN268201100005C / HL / NHLBI NIH HHS / United States
HHSN268201100007I / HL / NHLBI NIH HHS / United States
HHSN268201000010C / HL / NHLBI NIH HHS / United States