| Institution: | 1. Kolling Research Institute, University of Sydney, Sydney, Australia;2. Imaging and Phenotyping Laboratory, Charles Perkins Centre and Faculty of Medicine and Health, University of Sydney, Sydney, Australia;3. Clinical Trials Center, New York, New York, USA;4. Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden;5. Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany;6. Division of Cardiology, Duke University Hospital, Durham, North Carolina, USA;7. Division of Cardiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA;8. Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA;9. Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA;10. University Heart Center Lübeck and the German Center for Cardiovascular Research, Lübeck, Germany;11. Division of Cardiovascular Medicine, University of California–San Diego, San Diego, California, USA;12. The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA;13. Division of Cardiology, Memorial Sloan Kettering Cancer Center and Weill-Cornell College of Medicine, New York, New York, USA |
| Abstract: | BackgroundThe author recently reported ～50% excess early mortality in patients with first-presentation ST-segment elevation myocardial infarction (STEMI) without standard modifiable cardiovascular risk factors (SMuRFs); the cause of this is not clear.ObjectivesThe aim of this study was to examine differences in infarct characteristics and clinical outcomes in patients with versus without SMuRFs (dyslipidemia, hypertension, diabetes mellitus, and smoking).MethodsIndividual-level data were pooled from 10 randomized percutaneous intervention (PCI) trials in which infarct size was measured within 1 month by either cardiac magnetic resonance or technetium-99m sestamibi single-photon emission computed tomography imaging. First-presentation STEMI was classified into 2 groups according to the presence or absence of at least 1 SMuRF.ResultsAmong 2,862 patients, 524 (18.3%) were SMuRF-less. After adjusting for study effect, SMuRF-less patients had more frequent poor pre-PCI flow Thrombolysis In Myocardial Infarction 0/1 compared with patients with at least 1 SMuRF (72.0% vs 64.1%; OR: 1.35; 95% CI: 1.08-1.70). There were no independent associations between the presence or absence of SMuRFs at baseline and infarct size (estimate = ?0.35; 95% CI: ?1.93 to 1.23), left ventricular ejection fraction (estimate = ?0.06; 95% CI: ?1.33 to 1.20), or mortality at 30 days (HR: 0.46; 95% CI: 0.19-1.07) and 1 year (HR: 0.74; 95% CI: 0.43-1.29).ConclusionsFirst-presentation STEMI patients with no identifiable baseline SMuRFs had a higher risk of Thrombolysis In Myocardial Infarction flow grade 0/1 pre-PCI. However, after adjustment, there were no significant associations between SMuRF-less status and infarct size, left ventricle ejection fraction, or mortality. |
