TY - JOUR
T1 - Clinical Outcomes in Patients With ST-Segment Elevation MI and No Standard Modifiable Cardiovascular Risk Factors
AU - Figtree, Gemma A.
AU - Redfors, Bjorn
AU - Kozor, Rebecca
AU - Vernon, Stephen T.
AU - Grieve, Stuart M.
AU - Mazhar, Jawad
AU - Thiele, Holger
AU - Patel, Manesh R.
AU - Udelson, James E.
AU - Selker, Harry P.
AU - Ohman, E. Magnus
AU - Maehara, Akiko
AU - Karmpaliotis, Dmitri
AU - Eitel, Ingo
AU - Granger, Christopher B.
AU - Ben-Yehuda, Ori
AU - Stone, Gregg W.
AU - Kosmidou, Ioanna
N1 - Publisher Copyright:
© 2022 The Authors
PY - 2022/6/13
Y1 - 2022/6/13
N2 - Background: The author recently reported ∼50% excess early mortality in patients with first-presentation ST-segment elevation myocardial infarction (STEMI) without standard modifiable cardiovascular risk factors (SMuRFs); the cause of this is not clear. Objectives: The aim of this study was to examine differences in infarct characteristics and clinical outcomes in patients with versus without SMuRFs (dyslipidemia, hypertension, diabetes mellitus, and smoking). Methods: Individual-level data were pooled from 10 randomized percutaneous intervention (PCI) trials in which infarct size was measured within 1 month by either cardiac magnetic resonance or technetium-99m sestamibi single-photon emission computed tomography imaging. First-presentation STEMI was classified into 2 groups according to the presence or absence of at least 1 SMuRF. Results: Among 2,862 patients, 524 (18.3%) were SMuRF-less. After adjusting for study effect, SMuRF-less patients had more frequent poor pre-PCI flow Thrombolysis In Myocardial Infarction 0/1 compared with patients with at least 1 SMuRF (72.0% vs 64.1%; OR: 1.35; 95% CI: 1.08-1.70). There were no independent associations between the presence or absence of SMuRFs at baseline and infarct size (estimate = −0.35; 95% CI: −1.93 to 1.23), left ventricular ejection fraction (estimate = −0.06; 95% CI: −1.33 to 1.20), or mortality at 30 days (HR: 0.46; 95% CI: 0.19-1.07) and 1 year (HR: 0.74; 95% CI: 0.43-1.29). Conclusions: First-presentation STEMI patients with no identifiable baseline SMuRFs had a higher risk of Thrombolysis In Myocardial Infarction flow grade 0/1 pre-PCI. However, after adjustment, there were no significant associations between SMuRF-less status and infarct size, left ventricle ejection fraction, or mortality.
AB - Background: The author recently reported ∼50% excess early mortality in patients with first-presentation ST-segment elevation myocardial infarction (STEMI) without standard modifiable cardiovascular risk factors (SMuRFs); the cause of this is not clear. Objectives: The aim of this study was to examine differences in infarct characteristics and clinical outcomes in patients with versus without SMuRFs (dyslipidemia, hypertension, diabetes mellitus, and smoking). Methods: Individual-level data were pooled from 10 randomized percutaneous intervention (PCI) trials in which infarct size was measured within 1 month by either cardiac magnetic resonance or technetium-99m sestamibi single-photon emission computed tomography imaging. First-presentation STEMI was classified into 2 groups according to the presence or absence of at least 1 SMuRF. Results: Among 2,862 patients, 524 (18.3%) were SMuRF-less. After adjusting for study effect, SMuRF-less patients had more frequent poor pre-PCI flow Thrombolysis In Myocardial Infarction 0/1 compared with patients with at least 1 SMuRF (72.0% vs 64.1%; OR: 1.35; 95% CI: 1.08-1.70). There were no independent associations between the presence or absence of SMuRFs at baseline and infarct size (estimate = −0.35; 95% CI: −1.93 to 1.23), left ventricular ejection fraction (estimate = −0.06; 95% CI: −1.33 to 1.20), or mortality at 30 days (HR: 0.46; 95% CI: 0.19-1.07) and 1 year (HR: 0.74; 95% CI: 0.43-1.29). Conclusions: First-presentation STEMI patients with no identifiable baseline SMuRFs had a higher risk of Thrombolysis In Myocardial Infarction flow grade 0/1 pre-PCI. However, after adjustment, there were no significant associations between SMuRF-less status and infarct size, left ventricle ejection fraction, or mortality.
KW - ST-segment elevation myocardial infarction
KW - atherosclerosis
KW - cardiovascular risk factors
KW - coronary artery disease
UR - http://www.scopus.com/inward/record.url?scp=85130837226&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2022.03.036
DO - 10.1016/j.jcin.2022.03.036
M3 - Article
C2 - 35680197
AN - SCOPUS:85130837226
SN - 1936-8798
VL - 15
SP - 1167
EP - 1175
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 11
ER -