Key result
SMuRF-less STEMI is linked to similar 60-day but ~17% lower long-term MACE risk.
Why the study?
Studies primarily outside the United States reported that SMuRF-less STEMI patients are common and have worse short-term prognosis, prompting evaluation of their proportion and outcomes in a large US healthcare population.
Does the absence of standard modifiable risk factors (SMuRF-less) affect short- and long-term outcomes in patients presenting with a first STEMI?
Observational (n=3,510)
Yes
Does the absence of standard modifiable risk factors (SMuRF-less) affect short- and long-term outcomes in patients presenting with a first STEMI?
In a large US cohort, SMuRF-less STEMI patients had similar short-term and more favorable long-term outcomes compared to those with standard modifiable risk factors, contrasting with prior non-US reports.
Answers are grounded in this paper and cite their sources.
SMuRF-less STEMI was associated with lower long-term MACE; leaves open whether this reflects true benefit or unmeasured confounding versus prior reports.
Studies primarily outside the United States have reported that SMuRF-less STEMI patients are surprisingly common (14–27%) and have a worse in-hospital/short-term prognosis. Given potential demographic and management differences over time and in the US, we aimed to identify the proportion and outcomes of SMuRF-less STEMI patients in a large US healthcare population. Patients with a first STEMI presenting to Intermountain Healthcare catheterization laboratories between 2001–2021 were included. SMuRF included a clinical diagnosis of, or treatment for, hypertension, hyperlipidemia, diabetes, and smoking. Follow-up MACE were defined as death, MI, and heart failure hospitalization (HFH) by 60 days and long-term. Qualifying STEMI patients totaled 3510, 26.2% (919) with no SMuRF. SMuRF-less patients were younger, more frequently male, and had fewer comorbidities. Neither total MACE (adj HR 0.95, p = 0.72) nor death (adj HR 1.06, p = 0.69) differed by SMuRF status at 60 days. Long-term outcomes were more frequent in SMuRF patients, which remained significant for total MACE (adj HR 0.83, p = 0.02) and HFH (HR 0.36, p = 0.0005) after adjustment for baseline differences other than SMuRF. Results were consistent through subgroup and sensitivity analyses. In this moderately large US healthcare population, SMuRF-less STEMI presentation was confirmed to be common (26.2%). However, unlike earlier, mostly non-US reports, adjusted short-term outcomes were similar, and long-term outcomes were more favorable. Further studies to increase understanding, recognition, and treatment of risk factors in SMuRF-less subjects and to optimize STEMI management are indicated.
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Anderson et al. (2022) conducted an observational in ST-Elevation Myocardial Infarction (STEMI) (n=3,510). Absence of standard modifiable risk factors (SMuRF-less) vs. Presence of standard modifiable risk factors (SMuRF) was evaluated on 60-day Major Adverse Cardiovascular Events (MACE) (HR 0.95, 95% CI 0.72, 1.25, p=0.72). STEMI patients without standard modifiable risk factors had similar 60-day MACE rates (HR 0.95) but significantly lower long-term MACE rates (HR 0.83) compared to patients with standard risk factors.
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