Journal
JACC-CARDIOVASCULAR INTERVENTIONS
Volume 15, Issue 11, Pages 1167-1175Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jcin.2022.03.036
Keywords
atherosclerosis; cardiovascular risk factors; coronary artery disease; ST-segment elevation myocardial infarction
Categories
Funding
- National Health and Medical Research Council Practitioner Fellowship [APP11359290]
- Heart Research Australia
- New South Wales Office of Health and Medical Research
- Parker-Hughes Bequest
- Frecker Family
- National Health and Medical Research Council (Australia) Practitioner Fellowship
- New SouthWales Office of Health and Medical Research (Senior Investigator grant)
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First-presentation STEMI patients without standard modifiable cardiovascular risk factors (SMuRFs) have 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 ventricular ejection fraction, or mortality.
BACKGROUND The author recently reported similar to 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. (C) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
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