Key result
SMuRF-less STEMI is linked to ~43% higher in-hospital mortality compared to having standard risk factors.
Why the study?
There are limited data on outcomes and pathophysiology of STEMI in patients without standard modifiable risk factors (SMuRFs).
Does the absence of standard modifiable risk factors affect in-hospital mortality and treatment in patients with a first STEMI episode?
Meta-Analysis (n=521,150)
Does the absence of standard modifiable risk factors affect in-hospital mortality and treatment in patients with a first STEMI episode?
Patients presenting with a first STEMI without standard modifiable risk factors paradoxically experience higher in-hospital mortality and cardiogenic shock, and are less likely to receive guideline-directed medical therapy at discharge.
Answers are grounded in this paper and cite their sources.
SMuRF-less STEMI patients warrant heightened in-hospital vigilance; meta-analysis extends observational data but leaves optimal management open.
There are limited data available on outcomes and pathophysiology behind ST-segment elevation myocardial infarction (STEMI) in populations without standard modifiable risk factors (SMuRFs). The authors carried out this meta-analysis to understand the differences in treatment and outcomes of STEMI patients with and without SMuRFs. Methods: A systematic database search was performed for relevant studies. Studies reporting desired outcomes among STEMI patients with and without SMuRFs were selected based on predefined criteria in the study protocol (PROSPERO: CRD42022341389). Two reviewers independently screened titles and abstracts using Covidence. Full texts of the selected studies were independently reviewed to confirm eligibility. Data were extracted from all eligible studies via a full-text review of the primary article for qualitative and quantitative analysis. In-hospital mortality following the first episode of STEMI was the primary outcome, with major adverse cardiovascular events (MACE), repeat myocardial infarction (MI), cardiogenic shock, heart failure, and stroke as secondary outcomes of interest. Odds ratio (OR) with a 95% CI was used to estimate the effect. Results: A total of 2135 studies were identified from database search, six studies with 521 150 patients with the first STEMI episode were included in the analysis. The authors found higher in-hospital mortality (OR: 1.43; CI: 1.40-1.47) and cardiogenic shock (OR: 1.59; 95% CI: 1.55-1.63) in the SMuRF-less group with no differences in MACE, recurrent MI, major bleeding, heart failure, and stroke. There were lower prescriptions of statin (OR: 0.62; CI: 0.42-0.91) and Angiotensin converting enzyme inhibitor /Angiotensin II receptor blocker (OR: 0.49; CI: 0.28-0.87) at discharge in SMuRF-less patients. There was no difference in procedures like coronary artery bypass graft, percutaneous coronary intervention, and thrombolysis. Conclusion: In the SMuRF-less STEMI patients, higher in-hospital mortality and treatment discrepancies were noted at discharge.
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Shrestha et al. (2023) conducted a meta-analysis in ST-segment elevation myocardial infarction (STEMI) (n=521,150). Absence of standard modifiable risk factors (SMuRF-less) vs. Presence of standard modifiable risk factors was evaluated on In-hospital mortality (OR 1.43, 95% CI 1.40-1.47). STEMI patients without standard modifiable risk factors had higher in-hospital mortality and cardiogenic shock compared to those with risk factors.
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