Clinical outcomes and optical coherence tomography findings in myocardial infarction patients without standard modifiable risk factors: insights from the TACTICS registry

Background Patients with coronary artery disease who luck any standard modifiable cardiovascular risk factors (SMuRFs; hypertension, diabetes mellitus, dyslipidemia, and smoking) have attracted much attention in recent years due to their unexpectedly poor clinical outcomes. Purpose The aim of the present study was to evaluate the characteristics and coronary culprit lesions of patients without any SMuRFs using optical coherence tomography (OCT) in acute myocardial infarction (AMI) patients in a prospective multicenter registry. Methods Patients with AMI diagnosed within 24 hours of symptom onset who underwent OCT- guided emergency percutaneous coronary intervention were enrolled. The primary endpoint of the study was to identify the characterization of coronary artery lesions in patients who didn’t have any SMuRFs. Results 640 AMI patients were enrolled in the present study and 9% of patients did not have any SMuRFs. They were older, had lower BMIs, and tended to be in poor condition, including cardiogenic shock. OCT findings showed no difference in the morphology of the culprit lesions, however the incidence rates of lipid plaques lesion or calcified plaque greater than 180 degrees were lower in patients without SMuRFs. Patients without any SMuRFs had higher risk of cardiovascular events at 12- month follow-up compared patients with SMuRFs (adjusted hazard ratio 1.88, 95% confidence interval 1.01-3.51, p=0.048). Conclusions From the preset OCT study, patients who did not have any SMuRFs had less lipid plaque and severe calcification lesions compared with patients with SMuRFS. The reason for the poor prognosis in this patient group is not the morphology of the coronary artery lesions, but rather the poor state of the patients at the time of onset.