Can we identify vulnerable patients at risk for ST-segment elevation myocardial infarction based on their clinical characteristics?

Objective Coronary artery plaque rupture is a sudden, unpredictable event leading to acute coronary syndrome. Thus far, there is no clinical characteristic to distinguish the patients at risk for acute myocardial infarction from those with more stable coronary artery disease. The purpose of this study was to identify clinical predictors of first ST-segment elevation myocardial infarction (STEMI). Methods We retrospectively compared 116 consecutive patients presenting with their first STEMI for primary angioplasty and 216 ambulatory patients with stable angina requiring their first coronary intervention. Results Patients with STEMI were younger, more likely to be smokers, but less likely to have hypertension or hypercholesterolemia. Diabetes was present equally between the two groups. Cardioprotective medication usage, such as aspirin and statin, was much lower among patients presenting with their first STEMI. Conclusions Thus, patients with STEMI presumably from plaque rupture have fewer traditional risk factors compared with patients with stable angina. Identifying these vulnerable patients at risk for plaque rupture may enable early institution of cardioprotective pharmacotherapy to prevent their first acute coronary syndrome occurrence. (C) 2004 Lippincott Williams Wilkins.