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. 2025 Apr 11;14(8):2645.
doi: 10.3390/jcm14082645.

Poor Mental Health Status as a Risk Factor and Prognosticator in SMuRF-Less Acute Myocardial Infarction

Dimitrios V Moysidis  1 , Georgios Giannopoulos  1 , Vasileios Anastasiou  2 , Stylianos Daios  2 , Andreas S Papazoglou  3 , Alexandros C Liatsos  3 , Efstathios Spyridonidis  3 , Vasileios Kamperidis  2 , Matthaios Didagelos  2 , Georgios Tagarakis  4 , Christos Savopoulos  5 , Panagiotis Kyriakidis  3 , Sonia Konstantinidou  1 , George Giannakoulas  2 , Vassilios Vassilikos  1 , Antonios Ziakas  2
Affiliations

Poor Mental Health Status as a Risk Factor and Prognosticator in SMuRF-Less Acute Myocardial Infarction

Dimitrios V Moysidis et al. J Clin Med. .

Abstract

Background: The etiology of acute myocardial infarction (AMI) in patients without history of standard modifiable risk factors (SMuRFs) remains unclear. Simultaneously, evidence suggests that mental health status (MHS) contributes to the pathogenesis of AMI and worsens its outcomes. Methods: This analysis of the prospective "Beyond-SMuRFs" (NCT05535582) study included 650 consecutive patients with AMI who had available data on self-reported MHS before AMI, calculated by the SF36-Questionnaire mental component summary (MCS). Poor MHS was defined as MCS ≤ 50. Multivariable logistic-regression and Cox-regression analyses were implemented to investigate poor MHS as a potential predictor of SMuRF-less AMIs and compare all-cause mortality based on SMuRF-less and MH status, respectively. Results: Of 650 patients with AMI (mean age 62.6 ± 12.1 years), 288 (44.3%) had MCS ≤ 50 and 128 (19.7%) were SMuRF-less patients. Three out of four SMuRF-less patients reported an MCS ≤ 50 (n = 96, 75%), a significantly higher percentage than the corresponding percentage in patients with SMuRFs (n = 192, 36.8%; p < 0.01). The multivariable logistic regression model showed that MCS ≤ 50 was an independent predictor of SMuRF-less AMI [aOR = 0.95; 95% CI (0.94-0.96)]. Time-to-event analysis for all-cause mortality showed that patients with MCS > 50 had lower mortality rates than those with poor MHS (aHR, 3.61 [95% CI, 2.02 to 6.43], p < 0.01). Higher risk for all-cause mortality was also observed in SMuRF-less patients with poor MHS compared to patients with at least one SMuRF and good MHS [aHR, 4.52 (95% CI, 0.94-21.73)]. Conclusions: Poor MHS was an independent predictor of the occurrence of SMuRF-less AMI and predictive of higher mortality in patients with and without SMuRFs.

Keywords: acute myocardial infarction; coronary artery disease; mental component summary; mental health status; standard modifiable risk factors.

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Conflict of interest statement

The authors declare that there are no conflicts of interest.

Figures

Figure 1
Figure 1
Graphical illustration of the SF-36 items included in MCS.
Figure 2
Figure 2
Correlation between the self-reported mental health status score (x axis) before AMI and the adjusted odds ratio (95% CI) for the probability of SMuRF-less AMI (y axis). The color scale corresponds to a gradual reduction in self-reported MCS scoring (from blue to red). These spline curves represent the adjusted odds ratios for the probability of a patient presenting with AMI being SMuRF-less depending on self-reported MCS. The edges of the darker area display 95% confidence intervals (CIs).
Figure 3
Figure 3
Time-to-event analysis for all-cause mortality in each SF-36 MCS subgroup.
Figure 4
Figure 4
Time-to-event analysis for all-cause mortality according to SMuRF-less and mental status.
Figure 5
Figure 5
Potential pathophysiological mechanisms of mental-stress-induced myocardial infarction.
See this image and copyright information in PMC

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