Background
Recently, the impact of the lack of standard modifiable risk factors, including hypertension,
diabetes, dyslipidaemia, and current smoking, has been investigated in ST-segment
elevation myocardial infarction (MI). The present study aimed to evaluate clinical
characteristics and prognosis of the patients with no standard risk factors in acute
MI.
Methods
This bi-centre registry included 1,093 patients with acute MI undergoing percutaneous
coronary intervention. The participants were divided into two groups: patients having
at least one of the four standard risk factors and those having none of the risk factors.
The study endpoints included major adverse cardiovascular events (MACE) (death, recurrent
MI, and stroke) and major bleeding events during hospitalisation. Any MACE and major
bleeding events after discharge were also evaluated as an exploratory analysis.
Results
Of 1,093 patients, 64 (5.9%) had none of the four standard risk factors. The patients
with no standard risk factors were likely to present with Killip class IV and cardiac
arrest. The rate of in-hospital MACE was higher in patients with no risk factors than
in their counterparts (25.0% vs 9.9%; p<0.001), whereas the incidence of in-hospital
major bleeding was not significantly different between the two groups (9.4% vs 6.7%;
p=0.44). Active cancer and autoimmune/inflammatory diseases were often found in patients
with no standard risk factors. After discharge, no significant differences were observed
in the risks of MACE and major bleeding events between the two groups.
Conclusions
No standard modifiable risk factors were not uncommon and were associated with poor
short-term outcomes in patients with acute MI.
Keywords
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Article info
Publication history
Published online: July 14, 2022
Accepted:
June 15,
2022
Received in revised form:
June 10,
2022
Received:
March 11,
2022
Identification
Copyright
© 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
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Access this article on ScienceDirectLinked Article
- Why Me? The Rise of Patients Without Traditional Cardiovascular Risk FactorsHeart, Lung and CirculationVol. 31Issue 9
- PreviewPatients lacking the traditional cardiovascular risk factors of hypertension, dyslipidaemia, diabetes mellitus or a history of smoking have previously been described as SMuRFless (Standard Modifiable Risk Factor-less) and recognised to represent an increasing proportion of acute coronary syndromes (ACS) and cardiac arrest with poor outcomes [1–4]. In this edition of Heart Lung and Circulation, Suzuki and Saito et al. [5] detail their insights into a population of over 1,000 patients enrolled in a Japanese percutaneous coronary intervention (PCI) registry.
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