Mortality in STEMI patients without standard modifiable

The gap

Evidence profile

Stated in the limitations and inline gaps sections of the source papers, classified as general, spanning 3 journals. Those papers have been cited 3 times in total.

Supporting evidence — 3 representative gaps

• Association between high ratio of platelet concentrate to red blood cell and survival among massively transfused patients (2026) · European Journal of Trauma and Emergency Surgery · doi

  This study has several limitations. First, we retrospectively defined massive transfusion within 24 h of injury; therefore, the study population may differ from other definitions used to evaluate high PC strategies. Second, selection bias between the high- and low-PC groups is possible, as patients who survived initial resuscita- tion may have received higher PC-to-RBC ratios. Although time-dependent analysis would better address this issue, data on transfusion timing were unavailable. We performed sensitivity analyses excluding emergency department deaths and patients without PC transfusion to assess robustness; however, residual bias cannot be excluded. Third, as a retrospective observational study, unmeasured confounding is inevitable. In particular, TXA administra- tion was not fully protocolized during the study period and depended on physician discretion, which may have influ- enced outcomes. Fourth, external validity may be limited. Platelet units in Japan generally contain fewer platelets than standard apheresis units used in the United States and Europe (approximately 3–4 × 10¹¹ platelets per dose) [30], and thus equivalent PC-to-RBC ratios may not represent comparable absolute platelet doses. Fifth, cause-specific mortality and detailed neurological data were unavailable. Mortality in massively transfused patients may also be influenced by intracranial hemorrhage and neurological deterioration. Although improved in-hos- pital survival was also observed in the high PC group, the impact of transfusion strategy on neurological outcomes remains uncertain. M. Aoki et al.1 3 Page 9 of 10 134 the chest, abdomen or pelvis, AIS for the head/neck, chest, abdomen, and pelvis/lower extremity, ISS and administration of tranexamic acid, with a ratio of 1 as a reference. PC, platelet concentrate; RBC, red blood cell; FFP, fresh frozen plasma; CCI, charlson comorbidity index; CT, computed tomography; AIS, abbreviated injury scale; ISS, injury severity score Data availability The data that support the findings of this study are available from the corresponding author upon reasonable request.

  generalstated in limitationsevidence 5/5
  Keywords: transfusion injury high patients platelet neurological used bias tion ratios unavailable outcomes units platelets mortality
• Risk factors associated with ventricular fibrillation during first ST-elevation myocardial infarction: Individual participant data analysis of 3 prospective case-control studies (2026) · Heart Rhythm · cited 3× · doi

  Even though the 3 studies were all designed specifically to study VF during first STEMI, comprised a large population, and comprehensively phenotyped individuals, our findings should be interpreted considering several limitations, some of which have already been mentioned earlier. Observational studies are always at risk of confounding, and even though we adjusted based on a thorough evaluation of causal pathways, we cannot rule out unmeasured confounding. Only patients who arrived at the hospital and received reperfusion therapy were included in the studies. Thus, some selection bias is pre- sent: patients with VF as their first symptom and/or unwit- nessed cardiac lower probability of resuscitation and survival until hospitalization. As a result, the phenotype of VF cases in this study is not necessarily the same as in all victims to SCD caused by CAD, and results cannot necessarily be extrapolated to populations not included in the study population. arrest have a Patients were interviewed after the event, which increases the risk of recall bias. Patients who have had a cardiac arrest may be more prone to recall SD in their family; however, we believe this risk to be small. After a cardiac arrest, patients may experience retrograde amnesia, or if still comatose, the relatives may be unaware of the immediate circumstances or history. This increases the prevalence of missing data not at random of patients in the case group. Patients using antiar- rhythmic drugs were excluded from the study so results cannot be extrapolated to this subgroup. For example, this might have selected patients with less symptomatic AF, and it is difficult to judge whether results would be the same in in- dividuals receiving, for example, class I or III antiarrhythmic drugs. Finally, the results are vulnerable to misclassification of cases. Postresuscitation ECGs and cardiac enzymes can be difficult to interpret, and deciding whether cardiac arrest judgment. is caused by acute MI demands strong clinical Falsely including cases with a different phenotype, for example, primary arrhythmia or chronic ischemia, could alter the results. Thorough evaluation and adjudication of cases have been done to minimize this effect. Finally, the study is epidemiologic in nature, and further studies are needed to assess genetic, electrical, and mechanistic insights into the ar- rhythmogenesis during acute ischemia.

  generalstated in limitationsevidence 5/5
  Keywords: patients cardiac cases arrest risk cannot example even though population confounding thorough evaluation included bias
• Redefining atherosclerotic cardiovascular disease patients with no standard modifiable risk factors “SMuRF-less”: six rather than four risk factors. Analysis from the Jordan SMuRF-less Study (2026) · Frontiers in Cardiovascular Medicine · doi

  Mortality in STEMI patients without standard modifiable risk factors: a sex- disaggregated analysis of SWEDEHEART registry data. Mortality in patients hospitalised with acute myocardial infarction without standard modifiable risk factors: the ARIC study community surveillance. Higher mortality in acute coronary syndrome patients without standard modifiable risk factors: results from a global meta-analysis of 1,285,722 patients. ST-Segment– Elevation myocardial infarction (STEMI) patients without standard modifiable cardiovascular risk factors—how common are they, and what are their outcomes? J Am Heart Assoc. Prognostic outcomes in acute myocardial infarction patients without standard modifiable risk factors: a multiethnic study of 8,680 Asian patients. Clinical outcomes in patients with ST-segment elevation MI and No standard modifiable cardiovascular risk factors. Patients with STEMI without standard modifiable risk factors.

  generalstated in inline gapsevidence 5/5
  Keywords: patients standard modifiable risk factors without mortality stemi acute myocardial infarction outcomes segment elevation cardiovascular

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