title: Cardiovascular Risk Factors and In-hospital Mortality in Acute Coronary Syndromes: Insights From the Canadian Global Registry of Acute Coronary Events.
abstract: BACKGROUND
  There are conflicting data regarding the relationship between the number of modifiable traditional risk factors and prognosis in acute coronary syndromes (ACS). This controversy might in part be explained by the differential use of prehospital medications.
  
  
  METHODS
  Using data from the Canadian, multicentre Global Registry of Acute Coronary Events (GRACE) (1999-2008), we stratified 13,686 ACS patients into 3 groups (0, 1-2, vs 3-4 risk factors) and compared their baseline characteristics, in-hospital treatments, and outcomes. Multivariable logistic regressions were performed to adjust for the components of the GRACE risk score and preadmission statin and acetylsalicylic acid (ASA) use.
  
  
  RESULTS
  Among these patients (ST-elevation myocardial infarction 28.3%), 14.5%, 62.6%, and 22.9% had 0, 1-2, and 3-4 risk factors, respectively. Patients with fewer risk factors were less likely to be on ASA, statin, and other prehospital medications. Unadjusted in-hospital mortality was significantly different across risk factor groups (4.9%, 3.0%, and 3.1% for 0, 1-2, and 3-4 risk factor groups, respectively, P for trend = 0.002). This difference was no longer significant after adjusting for the components of the GRACE risk score (P for trend = 0.088) and further adjusting for preadmission statin and ASA use (P for trend = 0.96). For in-hospital mortality, there was no significant interaction between risk factor categories and ACS type (P = 0.26).
  
  
  CONCLUSIONS
  The lower mortality observed in patients with ACS with more risk factors may be partially attributed to the protective effect of prehospital ASA and statin use. The number of risk factors does not provide incremental prognostic value beyond the validated GRACE risk score.
authors.affiliation: Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jenny Y
authors.initials: JY
authors.lastname: Wang
authors.affiliation: Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Heart Research Centre, Toronto, Ontario, Canada. Electronic address: goodmans@smh.ca.
authors.forename: Shaun G
authors.initials: SG
authors.lastname: Goodman
authors.affiliation: Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ilana
authors.initials: I
authors.lastname: Saltzman
authors.affiliation: Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Graham C
authors.initials: GC
authors.lastname: Wong
authors.affiliation: McGill University Health Centre, McGill University, Montreal, Quebec, Canada.
authors.forename: Thao
authors.initials: T
authors.lastname: Huynh
authors.affiliation: Québec Heart and Lung Institute, Laval Hospital, Québec City, Quebec, Canada.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Dery
authors.affiliation: Division of Endocrinology and Metabolism, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Leiter
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: Mazankowski Alberta Heart Institute, University of Alberta Hospital, Canadian VIGOUR Centre, Edmonton, Alberta, Canada.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Welsh
authors.affiliation: Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Spencer
authors.affiliation: Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Keith A A
authors.initials: KA
authors.lastname: Fox
authors.affiliation: Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: yana@smh.ca.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Yan
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000401:mortality*; D000368:Aged; D002170:Canada; D002423:Cause of Death; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012042:Registries; D012307:Risk Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors