Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Dec 20:10:1235667.
doi: 10.3389/fcvm.2023.1235667. eCollection 2023.

In-hospital and 1-year outcomes of patients without modifiable risk factors presenting with acute coronary syndrome undergoing PCI: a Sex-stratified analysis

Ali Sheikhy  1   2 , Aida Fallahzadeh  1   2 , Mana Jameie  1   2 , Afsaneh Aein  1   2 , Farzad Masoudkabir  1   2 , Milad Maghsoudi  3 , Masih Tajdini  1   2 , Mojtaba Salarifar  1   2 , Yaser Jenab  1   2 , Hamidreza Pourhosseini  1   2 , Mehdi Mehrani  1   2 , Mohammad Alidoosti  1   2 , Ali Vasheghani-Farahani  2 , Kaveh Hosseini  1   2
Affiliations

In-hospital and 1-year outcomes of patients without modifiable risk factors presenting with acute coronary syndrome undergoing PCI: a Sex-stratified analysis

Ali Sheikhy et al. Front Cardiovasc Med. .

Abstract

Aim: A considerable proportion of patients admitted with acute coronary syndrome (ACS) have no standard modifiable cardiovascular risk factors (SMuRFs: hypertension, diabetes mellitus, dyslipidemia, and cigarette smoking). The outcomes of this population following percutaneous coronary intervention (PCI) are debated. Further, sex differences within this population have yet to be established.

Methods: This retrospective cohort study included 7,847 patients with ACS who underwent PCI. The study outcomes were in-hospital mortality, all-cause mortality, and major adverse cardio-cerebrovascular events (MACCE). The association between the absence of SMuRFs (SMuRF-less status) and outcomes among all the patients and each sex was assessed using logistic and Cox proportional hazard regressions.

Results: Approximately 11% of the study population had none of the SMuRFs. During 12.13 [11.99-12.36] months of follow-up, in-hospital mortality (adjusted-odds ratio (OR):1.51, 95%confidence interval (CI): 0.91-2.65, P:0.108), all-cause mortality [adjusted-hazard ratio (HR): 1.01, 95%CI: 0.88-1.46, P: 0.731], and MACCE (adjusted-HR: 0.93, 95%CI:0.81-1.12, P: 0.412) did not differ between patients with and without SMuRFs. Sex-stratified analyses recapitulated similar outcomes between SMuRF+ and SMuRF-less men. In contrast, SMuRF-less women had significantly higher in-hospital (adjusted-OR: 3.28, 95%CI: 1.92-6.21, P < 0.001) and all-cause mortality (adjusted-HR:1.41, 95%CI: 1.02-3.21, P: 0.008) than SMuRF+ women.

Conclusions: Almost one in 10 patients with ACS who underwent PCI had no SMuRFs. The absence of SMuRFs did not confer any benefit in terms of in-hospital mortality, one-year mortality, and MACCE. Even worse, SMuRF-less women paradoxically had an excessive risk of in-hospital and one-year mortality.

Keywords: SMuRF-less; acute coronary syndrome; health status disparities; heart disease risk factors; mortality; percutaneous coronary intervention; sex difference.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The association between the sMuRF-less status and (A) in-hospital mortality, (B) all-cause mortality, and (C) MACCE, overall and by sex. MACCE, Major adverse cardio-cerebrovascular events.
Figure 2
Figure 2
Cumulative hazard function curves of all-cause mortality for (A) all the patients, (B) women, and (C) men.
Figure 3
Figure 3
Cumulative hazard function curves of MACCE for (A) all the patients, (B) women, and (C) men. MACCE, Major adverse cardio-cerebrovascular events.
Figure 4
Figure 4
Summary of study design and findings.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Grundy SM, Balady GJ, Criqui MH, Fletcher G, Greenland P, Hiratzka LF, et al. Primary prevention of coronary heart disease: guidance from Framingham: a statement for healthcare professionals from the AHA task force on risk reduction. American heart association. Circulation. (1998) 97(18):1876–87. 10.1161/01.CIR.97.18.1876 - DOI - PubMed
    1. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. (2017) 39(2):119–77. 10.1093/eurheartj/ehx393 - DOI - PubMed
    1. Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global burden of cardiovascular diseases and risk factors, 1990–2019: update from the GBD 2019 study. J Am Coll Cardiol. (2020) 76(25):2982–3021. 10.1016/j.jacc.2020.11.010 - DOI - PMC - PubMed
    1. Vernon ST, Coffey S, Bhindi R, Soo Hoo SY, Nelson GI, Ward MR, et al. Increasing proportion of ST elevation myocardial infarction patients with coronary atherosclerosis poorly explained by standard modifiable risk factors. Eur J Prev Cardiol. (2017) 24(17):1824–30. 10.1177/2047487317720287 - DOI - PubMed
    1. Figtree GA, Vernon ST, Hadziosmanovic N, Sundström J, Alfredsson J, Arnott C, et al. Mortality in STEMI patients without standard modifiable risk factors: a sex-disaggregated analysis of SWEDEHEART registry data. Lancet. (2021) 397(10279):1085–94. 10.1016/S0140-6736(21)00272-5 - DOI - PubMed