Abstract 15791: Risk Factor Burden and Control at the Time of Admission in Patients With Acute Myocardial Infarction: Results From the National Cardiovascular Data Registry
Introduction: Understanding risk factor burden and control as well as perceived risk prior to acute MI presentation may identify gaps in current risk assessment strategies and opportunities for system-based terventions to further improve cardiovascular health.
Methods: Patients presenting with acute MI in the ACTION Registry-GWTG were stratified into 5 mutually exclusive risk categories: Framingham Risk Score (FRS) <10%, FRS 10%-20%, FRS >20%, diabetes without prior CVD and prior CVD. Risk factor control metrics were determined at presentation and included: LDL, non-HDL, smoking status and aspirin use for secondary prevention. Lipid goals and statin eligibility were determined based on ATPIII as well as the 2013 ACC/AHA guidelines.
Results: Among 443,117 acute MI patients from Jan 2007 to Nov 2013, the mean age was 64±14 years and 34% were women. The distribution of patients across risk categories is shown in Table 1. Among participants without prior CVD or diabetes, only 14% were classified as high risk by FRS. At presentation, 67% of MI patients had LDL at goal, 67% had non-HDL at goal, 64% were not current smokers and 65% of patients with prior CVD were on aspirin. Only 36% of patients met all 4 risk factor control metrics. Overall statin eligibility prior to MI as determined by ATPIII was 61% and only 61% of statin-eligible patients were receiving them. In contrast, in an exploratory analysis utilizing the 2013 ACC/AHA guidelines, statin eligibility prior to MI presentation was estimated to be 90%.
Conclusions: Among patients presenting with acute MI who did not have diabetes or prior CVD, few would be classified as high risk and many would not have met ATPIII statin eligibility criteria prior to MI. In this population, overall risk factor control prior to MI was sub-optimal. These findings support both the need for more liberal treatment thresholds as recommended in the 2013 AHA/ACC guidelines as well as greater adherence to existing prevention targets.
Author Disclosures: A.R. Paixao: None. J.R. Enriquez: None. T.Y. Wang: Research Grant; Modest; Lilly USA, American Society of Nuclear Cardiology, Gilead Science, Daiichi Sankyo, GlaxoSmith Kline, American College of Cardiology. Consultant/Advisory Board; Modest; Astra Zeneca, American College of Cardiology Foundation. S. Li: None. A. Khera: None. S.R. Das: None. J.A. de Lemos: Consultant/Advisory Board; Modest; Amgen, Novo Nordisc, Janssen Pharmaceuticals. M.C. Kontos: None.
- © 2014 by American Heart Association, Inc.