Key result
Absence of standard cardiovascular risk factors is not associated with in-hospital death in ACS.
Why the study?
ACS without standard modifiable cardiovascular risk factors (SMuRFs) and acute stress hyperglycaemia may escape conventional risk assessment, and neither had been described in an Indonesian interventional population.
Does the absence of documented standard modifiable cardiovascular risk factors (SMuRFs) or a higher stress hyperglycaemia ratio (SHR) increase in-hospital all-cause mortality or index-event severity in patients with acute coronary syndrome undergoing PCI?
Cohort (n=1,702)
No
Does the absence of documented standard modifiable cardiovascular risk factors (SMuRFs) or a higher stress hyperglycaemia ratio (SHR) increase in-hospital all-cause mortality or index-event severity in patients with acute coronary syndrome undergoing PCI?
Answers are grounded in this paper and cite their sources.
In an Indonesian PCI registry, the apparent 12.0% prevalence of SMuRF-less ACS and the distribution of the stress hyperglycaemia ratio were heavily influenced by risk-factor definition, documentation periods, and laboratory boundary-value heaping, with neither marker significantly predicting in-hospital mortality or event severity.
Background Acute coronary syndrome (ACS) without standard modifiable cardiovascular risk factors (SMuRFs) and acute (stress) hyperglycaemia may both escape conventional risk assessment. Neither has been described in an Indonesian interventional population. Methods We analysed 1702 first ACS admissions in a single-centre Indonesian percutaneous coronary intervention registry (2021–2026). Patients with no documented hypertension, diabetes, dyslipidaemia or current smoking were classified as having no documented SMuRF. The stress hyperglycaemia ratio (SHR) was registry glucose divided by HbA1c-derived average glucose. Variables were audited for recording-bound heaping. Endpoints were in-hospital death and markers of index-event severity (Killip class III–IV, Killip class II–IV, ejection fraction <40%). Results In total, 204 patients (12.0%; 95% confidence interval [CI] 10.5–13.6) had no documented SMuRF, all admitted between April 2026 and July 2026; the proportion fell to 3.8% when ever-smoking replaced current smoking. These patients had a lower GRACE score and less multivessel percutaneous coronary intervention (odds ratio [OR] 0.46), but Killip class III–IV (OR 1.13, 0.80–1.60), ejection fraction <40% (1.14, 0.81–1.62) and death (0.82, 0.32–1.78) did not differ significantly. Median SHR was similar (1.27 vs 1.30, p = 0.731), but the distribution was narrower (standard deviation [SD] 0.25 vs 0.81), so the adjusted mean was lower (−0.17, −0.28 to −0.06). SHR was not associated with any severity marker. For death, the continuous estimate was inverse and non-significant (OR per SD 0.71, 0.45–1.05). Conclusions About one in eight patients had no documented SMuRF, but this estimate depended strongly on definition and recording period. SHR derived from the registry glucose value was not associated with index-event severity; these data do not support general conclusions about the prognostic value of SHR in ACS.
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Abadi et al. (2026) conducted a cohort in Acute coronary syndrome undergoing percutaneous coronary intervention (n=1,702). Absence of documented standard modifiable cardiovascular risk factors (no documented SMuRFs: hypertension, diabetes, dyslipidaemia, or current smoking) vs. Presence of >=1 documented standard modifiable cardiovascular risk factor (SMuRF-positive) was evaluated on In-hospital all-cause death (OR 0.82, 95% CI 0.32-1.78, p=0.637). Absence of documented SMuRFs was not significantly associated with in-hospital death (2.9% vs 3.1%; OR 0.82, 95% CI 0.32-1.78, p=0.637) or index-event severity in Indonesian ACS patients.
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