Clinical Outcomes in Patients With ST-Segment Elevation MI and No Standard Modifiable Cardiovascular Risk Factors

Gemma A Figtree¹, Bjorn Redfors², Rebecca Kozor³, Stephen T Vernon⁴, Stuart M Grieve⁵, Jawad Mazhar³, Holger Thiele⁶, Manesh R Patel⁷, James E Udelson⁸, Harry P Selker⁹, E Magnus Ohman⁷, Akiko Maehara¹⁰, Dmitri Karmpaliotis¹¹, Ingo Eitel¹², Christopher B Granger⁷, Ori Ben-Yehuda¹³, Gregg W Stone¹⁴, Ioanna Kosmidou¹⁵

Affiliations

¹ Kolling Research Institute, University of Sydney, Sydney, Australia; Imaging and Phenotyping Laboratory, Charles Perkins Centre and Faculty of Medicine and Health, University of Sydney, Sydney, Australia. Electronic address: gemma.figtree@sydney.edu.au.
² Clinical Trials Center, New York, New York, USA; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
³ Kolling Research Institute, University of Sydney, Sydney, Australia.
⁴ Kolling Research Institute, University of Sydney, Sydney, Australia; Imaging and Phenotyping Laboratory, Charles Perkins Centre and Faculty of Medicine and Health, University of Sydney, Sydney, Australia. Electronic address: https://twitter.com/steve_vern.
⁵ Imaging and Phenotyping Laboratory, Charles Perkins Centre and Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
⁶ Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany.
⁷ Division of Cardiology, Duke University Hospital, Durham, North Carolina, USA.
⁸ Division of Cardiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA.
⁹ Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA.
¹⁰ Clinical Trials Center, New York, New York, USA.
¹¹ Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA.
¹² University Heart Center Lübeck and the German Center for Cardiovascular Research, Lübeck, Germany.
¹³ Clinical Trials Center, New York, New York, USA; Division of Cardiovascular Medicine, University of California-San Diego, San Diego, California, USA.
¹⁴ Clinical Trials Center, New York, New York, USA; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Electronic address: https://twitter.com/GreggWStone.
¹⁵ Clinical Trials Center, New York, New York, USA; Division of Cardiology, Memorial Sloan Kettering Cancer Center and Weill-Cornell College of Medicine, New York, New York, USA. Electronic address: https://twitter.com/IKosmidou.

PMID: 35680197
DOI: 10.1016/j.jcin.2022.03.036

Free article

Clinical Outcomes in Patients With ST-Segment Elevation MI and No Standard Modifiable Cardiovascular Risk Factors

Gemma A Figtree et al. JACC Cardiovasc Interv. 2022.

Free article

. 2022 Jun 13;15(11):1167-1175.

doi: 10.1016/j.jcin.2022.03.036.

Authors

Affiliations

¹ Kolling Research Institute, University of Sydney, Sydney, Australia; Imaging and Phenotyping Laboratory, Charles Perkins Centre and Faculty of Medicine and Health, University of Sydney, Sydney, Australia. Electronic address: gemma.figtree@sydney.edu.au.
² Clinical Trials Center, New York, New York, USA; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
³ Kolling Research Institute, University of Sydney, Sydney, Australia.
⁴ Kolling Research Institute, University of Sydney, Sydney, Australia; Imaging and Phenotyping Laboratory, Charles Perkins Centre and Faculty of Medicine and Health, University of Sydney, Sydney, Australia. Electronic address: https://twitter.com/steve_vern.
⁵ Imaging and Phenotyping Laboratory, Charles Perkins Centre and Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
⁶ Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany.
⁷ Division of Cardiology, Duke University Hospital, Durham, North Carolina, USA.
⁸ Division of Cardiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA.
⁹ Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA.
¹⁰ Clinical Trials Center, New York, New York, USA.
¹¹ Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA.
¹² University Heart Center Lübeck and the German Center for Cardiovascular Research, Lübeck, Germany.
¹³ Clinical Trials Center, New York, New York, USA; Division of Cardiovascular Medicine, University of California-San Diego, San Diego, California, USA.
¹⁴ Clinical Trials Center, New York, New York, USA; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Electronic address: https://twitter.com/GreggWStone.
¹⁵ Clinical Trials Center, New York, New York, USA; Division of Cardiology, Memorial Sloan Kettering Cancer Center and Weill-Cornell College of Medicine, New York, New York, USA. Electronic address: https://twitter.com/IKosmidou.

PMID: 35680197
DOI: 10.1016/j.jcin.2022.03.036

Abstract

Background: The 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.

Objectives: The 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).

Methods: Individual-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.

Results: Among 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).

Conclusions: First-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.

Keywords: ST-segment elevation myocardial infarction; atherosclerosis; cardiovascular risk factors; coronary artery disease.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Figtree is supported by a National Health and Medical Research Council Practitioner Fellowship (grant number APP11359290), Heart Research Australia, and the New South Wales Office of Health and Medical Research. Prof Grieve is supported by the Parker-Hughes Bequest, the New South Wales Office of Health and Medical Research, and the Frecker Family. Dr Figtree has received funding from National Health and Medical Research Council (Australia) Practitioner Fellowship and New South Wales Office of Health and Medical Research (Senior Investigator grant). Dr Patel has received research grants from Bayer, Janssen, HeartFlow, National Heart, Lung, and Blood Institute; and has received advisory board/consulting fees from AstraZeneca, Bayer, Janssen, and HeartFlow. Dr Udelson has served on trial steering committees for Abiomed; and has served as a consultant for Imbria Pharmaceuticals. Dr Ohman has received research grants from Abiomed, Chiesi, and Portola, and consulting fees from Abiomed, Cara Therapeutics, Genentech, Imbria Pharmaceuticals, Impulse Dynamics, Janssen Pharmaceuticals, Medtronic, Medscape, Milestone Pharmaceuticals, and XyloCor Therapeutics. Dr Maehara has received grant support and consulting fees from Abbott Vascular and Boston Scientific. Dr Karmpaliotis has received honoraria from Abbott Vascular and Boston Scientific; and holds equity in Saranas, Soundbite, and Traverse Vascular. Dr Granger has received research grants from AstraZeneca, Food and Drug Administration, National Institutes of Health, GlaxoSmithKline, Medtronic, Novartis, Apple, Boehringer Ingelheim, BMS/Pfizer, and Janssen; and has received consulting fees from AstraZeneca, Espero, GlaxoSmithKline, Medtronic, Novartis, Boehringer Ingelheim, Boston Scientific, BMS/Pfizer, Daiichi-Sankyo, Merck, Roche, Eli Lilly, and Janssen. Dr Stone has received grants or contracts from Abbott (institutional); has received consulting fees from Valfix, TherOx, Robocath, HeartFlow, Ablative Solutions, Vectorious, Miracor, Neovasc, Abiomed, Ancora, Elucid Bio, Occlutech, CorFlow, Apollo Therapeutics, Impulse Dynamics, Reva, Shockwave, V-Wave, Cardiomech, Gore, Vascular Dynamics; has received honoraria from Cook and Infraredx; and holds stock (equity) in Ancora, Cagent, Applied Therapeutics, Biostar Family of Funds, Spectra Wave, Orchestra Biomed, Aria, Cardiac Success, Valfix, and MedFocus Family of Funds. Dr Kosmidou has received research grant support from Amgen and advisory board/consulting fees from Sanofi. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Comment in

Myocardial Infarction in Patients Without Cardiovascular Risk Factors: Advanced Prediction Models to Unlock the Clinical Dilemma?
Volpe M, Gallo G. Volpe M, et al. JACC Cardiovasc Interv. 2022 Jun 13;15(11):1176-1178. doi: 10.1016/j.jcin.2022.04.040. JACC Cardiovasc Interv. 2022. PMID: 35680198 No abstract available.
The SMuRFs and the SMuRF-Less Gargamel.
Moysidis DV, Papazoglou AS, Karagiannidis E. Moysidis DV, et al. JACC Cardiovasc Interv. 2022 Sep 26;15(18):1886. doi: 10.1016/j.jcin.2022.07.025. JACC Cardiovasc Interv. 2022. PMID: 36137698 No abstract available.
Reply: The SMuRFs and the SMuRF-Less Gargamel.
Figtree GA, Vernon ST, Grieve SM, Kosmidou I. Figtree GA, et al. JACC Cardiovasc Interv. 2022 Sep 26;15(18):1887. doi: 10.1016/j.jcin.2022.08.012. JACC Cardiovasc Interv. 2022. PMID: 36137699 No abstract available.

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Clinical Outcomes in Patients With ST-Segment Elevation MI and No Standard Modifiable Cardiovascular Risk Factors

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Clinical Outcomes in Patients With ST-Segment Elevation MI and No Standard Modifiable Cardiovascular Risk Factors

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