Why the study?
Patients with STEMI without standard modifiable cardiovascular risk factors have poorer outcomes, but the role of ethnicity in this population had not been investigated.
Does the absence of standard modifiable cardiovascular risk factors (SMuRFless) worsen outcomes in STEMI patients, and does ethnicity play a role?
Does the absence of standard modifiable cardiovascular risk factors (SMuRFless) worsen outcomes in STEMI patients, and does ethnicity play a role?
STEMI patients without standard modifiable cardiovascular risk factors have higher in-hospital mortality and MACE, though this difference is attenuated after adjusting for revascularization rates, with ethnic minorities more likely to undergo revascularization.
SMuRFless STEMI status signals higher adjusted MACE and mortality independent of ethnicity; extends prior registries but leaves mechanisms and practice implications open.
Trials suggest patients with ST-elevation myocardial infarction (STEMI) without ‘standard modifiable cardiovascular risk factors’ (SMuRFs) have poorer outcomes, but the role of ethnicity has not been investigated. We analyzed 118,177 STEMI patients using the Myocardial Ischaemia National Audit Project (MINAP) registry. Clinical characteristics and outcomes were analyzed using hierarchical logistic regression models; patients with ≥1 SMuRF (n = 88,055) were compared with ‘SMuRFless’ patients (n = 30,122), with subgroup analysis comparing outcomes of White and Ethnic minority patients. SMuRFless patients had higher incidence of major adverse cardiovascular events (MACE) (odds ratio, OR: 1.09, 95% CI 1.02–1.16) and in-hospital mortality (OR: 1.09, 95% CI 1.01–1.18) after adjusting for demographics, Killip classification, cardiac arrest, and comorbidities. When additionally adjusting for invasive coronary angiography (ICA) and revascularisation (percutaneous coronary intervention (PCI) or coronary artery bypass grafts surgery (CABG)), results for in-hospital mortality were no longer significant (OR 1.05, 95% CI .97–1.13). There were no significant differences in outcomes according to ethnicity. Ethnic minority patients were more likely to undergo revascularisation with ≥1 SMuRF (88 vs 80%, P < .001) or SMuRFless (87 vs 77%, P < .001. Ethnic minority patients were more likely undergo ICA and revascularisation regardless of SMuRF status.
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Weight et al. (2023) studied this question.
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