SMuRFless patients presenting with first-presentation STEMI had a significantly larger acute infarct size and smaller myocardial salvage index compared to patients with at least one risk factor, though 30-day mortality did not differ.
Cohort (n=2,046)
Blinded independent observer for CMR analysis
Yes
Does the absence of standard modifiable risk factors affect infarct size and clinical outcomes in patients presenting with first-presentation STEMI?
STEMI patients without standard modifiable risk factors have larger acute infarct sizes and smaller myocardial salvage indices, mediated by higher rates of LAD culprits and poor pre-PCI TIMI flow, though clinical outcomes were similar to those with risk factors.
Effect estimate: HR 1.7 (95% CI 0.8-3.6)
Absolute Event Rate: 3% vs 2%
p-value: p=0.20
Introduction A higher 30-day mortality has been observed in patients with first-presentation ST elevation myocardial infarction (STEMI) who have no standard modifiable cardiovascular risk factors (SMuRFs), i. e., diabetes, hypertension, hyperlipidemia, and current smoker. In this study, we evaluate the clinical outcomes and CMR imaging characteristics of patients with and without SMuRFs who presented with first-presentation STEMI. Methods Patients from the Third DANish Study of Acute Treatment of Patients With ST-Segment Elevation Myocardial Infarction (DANAMI-3) with first-presentation STEMI were classified into those with no SMuRFs vs. those with at least one SMuRF. Results We identified 2,046 patients; 283 (14%) SMuRFless and 1,763 (86%) had 0 SMuRF. SMuRFless patients were older (66 vs. 61 years, p 0.001) with more males (84 vs. 74%, p 0.001), more likely to have left anterior descending artery (LAD) as the culprit artery (50 vs. 42%, p = 0.009), and poor pre-PCI (percutaneous coronary intervention) TIMI (thrombolysis in myocardial infarction) flow ≤1 (78 vs. 64%; p 0.001). There was no difference in all-cause mortality, non-fatal reinfarction, or hospitalization for heart failure at 30 days or at long-term follow-up. CMR imaging was performed on 726 patients. SMuRFless patients had larger acute infarct size (17 vs. 13%, p = 0.04) and a smaller myocardial salvage index (42 vs. 50%, p = 0.02). These differences were attenuated when the higher LAD predominance and/or TIMI 0-1 flow were included in the model. Conclusion Despite no difference in 30-day mortality, SMuRFless patients had a larger infarct size and a smaller myocardial salvage index following first-presentation STEMI. This association was mediated by a larger proportion of LAD culprits and poor TIMI flow pre-PCI. Clinical trial registration clinicaltrials.gov, unique identifier: NCT01435408 (DANAMI 3-iPOST and DANAMI 3-DEFER) and NCT01960933 (DANAMI 3-PRIMULTI).
Mazhar et al. (Wed,) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=2,046). No standard modifiable cardiovascular risk factors (SMuRFless) vs. At least one standard modifiable cardiovascular risk factor (SMuRF > 0) was evaluated on All-cause mortality at 30 days (HR 1.7, 95% CI 0.8-3.6, p=0.20). SMuRFless patients presenting with first-presentation STEMI had a significantly larger acute infarct size and smaller myocardial salvage index compared to patients with at least one risk factor, though 30-day mortality did not differ.
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