Key result
Among patients with acute coronary syndrome, the absence of standard modifiable cardiovascular risk factors was associated with increased odds of having a zero SYNTAX score (OR 2.11).
Why the study?
A significant proportion of patients with ACS present without standard modifiable cardiovascular risk factors (SMuRFs), but angiographic severity of disease in this population had not yet been investigated.
Does the absence of standard modifiable cardiovascular risk factors (SMuRF-less status) affect angiographic severity and mortality in patients with acute coronary syndrome?
Observational (n=534)
No
Does the absence of standard modifiable cardiovascular risk factors (SMuRF-less status) affect angiographic severity and mortality in patients with acute coronary syndrome?
Answers are grounded in this paper and cite their sources.
Among patients with acute coronary syndrome, the absence of standard modifiable risk factors is associated with increased odds for non-obstructive CAD and increased short-term mortality.
Background Routine coronary artery disease (CAD) secondary prevention strategies target standard modifiable cardiovascular risk factors (SMuRFs), which include: diabetes mellitus, dyslipidemia, hypertension, and smoking. However, a significant proportion of patients with acute coronary syndrome (ACS) present without any SMuRFs. The angiographic severity of disease in this population has not yet been investigated. Methods After propensity score matching of patients without SMuRFs and patients with ≥1 SMuRFs (ratio 1:3), we used zero-inflated negative binomial regression modeling to investigate the relationship of SMuRF-less status with the angiographic severity of CAD, as measured by the SYNTAX score. Survival analysis was performed to investigate differences in all-cause mortality at 30 days and at the end of follow-up period. Results We analyzed 534 patients presenting with ACS who underwent coronary angiography. Of them, 56 (10.5%) presented without any SMuRF. After propensity score matching, the median SYNTAX score was 13.8 (IQR 0–22.1) in 56 SMuRF-less patients and 14 (IQR 5–25) in 166 patients with ≥1 SMuRFs. SMuRF-less status was associated with increased odds of zero SYNTAX score [zero-part model: odds ratio = 2.11, 95% confidence interval (CI): 1.03–4.33], but not with decreased SYNTAX score among patients with non-zero SYNTAX score (count-part model: incidence rate ratio = 0.99, 95% CI: 0.79–1.24); the overall distribution of the SYNTAX score was similar between the two groups (p = 0.26). The 30-day risk for all-cause mortality was higher for SMuRF-less patients compared to patients with ≥1 SMuRFs [hazard ratio (HR) = 3.58, 95% CI: 1.30–9.88]; however, the all-cause mortality risk was not different between the two groups over a median 1.7-year follow-up (HR = 1.72, 95% CI: 0.83–3.57). Conclusion Among patients with ACS, the absence of SMuRFs is associated with increased odds for non-obstructive CAD and with increased short-term mortality rates.
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Papazoglou et al. (2022) conducted an observational in Acute coronary syndrome (n=534). Absence of standard modifiable cardiovascular risk factors vs. Presence of ≥1 standard modifiable cardiovascular risk factors was evaluated on Zero SYNTAX score (OR 2.11, 95% CI 1.03-4.33). Among patients with acute coronary syndrome, the absence of standard modifiable cardiovascular risk factors was associated with increased odds of having a zero SYNTAX score (OR 2.11).
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