Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Department of Cardiology, National University Heart Centre, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
J Thromb Thrombolysis. 2022 Nov;54(4):569-578. doi: 10.1007/s11239-022-02704-7. Epub 2022 Sep 12.
A sizeable number of patients without standard modifiable cardiovascular risk factors (SMuRFs), such as hypertension, diabetes, hypercholesterolemia and smoking, suffer from acute coronary syndrome (ACS). These SMuRF-less patients have high short-term morbidity and mortality. We compared both short- and long-term outcomes of SMuRF-less and SMuRF ACS patients in a multi-ethnic Asian cohort.This was a retrospective study of patients with first ACS from 2011 to 2017. The primary outcome was long-term all-cause mortality. Secondary outcomes were 30-day all-cause mortality, cardiac-mortality, unplanned cardiac readmission, cardiogenic shock, heart failure, and stroke. Subgroup analysis was carried out by sex and ACS type.Of 5400 patients, 8.6% were SMuRF-less. The median follow-up time was 6.3 years (interquartile range [IQR] 4.2-8.2 years). SMuRF-less patients were younger and tended to present with ST-segment elevation myocardial infarction (STEMI). They were more likely to require inotropic support, intubation, and have cardiac arrest. At 30 days, SMuRF-less patients had higher rates of all-cause mortality, cardiac-related mortality and cardiogenic shock, but lower rates of heart failure. At 6 years, all-cause mortality was similar in both groups (18.0% versus 17.1% respectively, p = 0.631). Kaplan-Meier curves showed increased early mortality in the SMuRF-less group, but the divergence in survival curves was no longer present in the long-term. The absence of SMuRF was an independent predictor of mortality, regardless of sex or ACS type.In a multi-ethnic cohort of patients with ACS, SMuRF-less patients were observed to have higher mortality than SMuRF patients during the early stages which was attenuated over time.
大量没有标准可调节心血管风险因素（SMuRFs）的患者，如高血压、糖尿病、高胆固醇血症和吸烟，患有急性冠状动脉综合征（ACS）。这些没有 SMuRF 的患者短期发病率和死亡率较高。我们在一个多民族亚洲队列中比较了没有 SMuRF 和有 SMuRF 的 ACS 患者的短期和长期结果。这是一项对 2011 年至 2017 年首次 ACS 患者的回顾性研究。主要结局是长期全因死亡率。次要结局是 30 天全因死亡率、心脏死亡率、非计划性心脏再入院、心源性休克、心力衰竭和中风。亚组分析按性别和 ACS 类型进行。在 5400 名患者中，8.6%为无 SMuRF。中位随访时间为 6.3 年（四分位距 [IQR]：4.2-8.2 年）。无 SMuRF 的患者年龄较小，且倾向于表现为 ST 段抬高型心肌梗死（STEMI）。他们更可能需要正性肌力支持、插管和心脏骤停。在 30 天，无 SMuRF 的患者全因死亡率、心脏相关死亡率和心源性休克发生率较高，但心力衰竭发生率较低。在 6 年时，两组全因死亡率相似（分别为 18.0%和 17.1%，p=0.631）。Kaplan-Meier 曲线显示无 SMuRF 组早期死亡率较高，但在长期随访中，生存率曲线的差异不再存在。无论性别或 ACS 类型如何，无 SMuRF 都是死亡率的独立预测因素。在 ACS 患者的多民族队列中，无 SMuRF 的患者在早期阶段的死亡率高于有 SMuRF 的患者，但随着时间的推移，这种差异逐渐减弱。
