Sheikhy Ali, Fallahzadeh Aida, Jameie Mana, Aein Afsaneh, Masoudkabir Farzad, Maghsoudi Milad, Tajdini Masih, Salarifar Mojtaba, Jenab Yaser, Pourhosseini Hamidreza, Mehrani Mehdi, Alidoosti Mohammad, Vasheghani-Farahani Ali, Hosseini Kaveh
Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Front Cardiovasc Med. 2023 Dec 20;10:1235667. doi: 10.3389/fcvm.2023.1235667. eCollection 2023.
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, :0.108), all-cause mortality [adjusted-hazard ratio (HR): 1.01, 95%CI: 0.88-1.46, : 0.731], and MACCE (adjusted-HR: 0.93, 95%CI:0.81-1.12, : 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, < 0.001) and all-cause mortality (adjusted-HR:1.41, 95%CI: 1.02-3.21, : 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.
目的：相当一部分因急性冠状动脉综合征（ACS）入院的患者没有标准的可改变心血管危险因素（SMuRFs：高血压、糖尿病、血脂异常和吸烟）。经皮冠状动脉介入治疗（PCI）后该人群的预后存在争议。此外，该人群中的性别差异尚未明确。 方法：这项回顾性队列研究纳入了7847例接受PCI的ACS患者。研究结局为住院死亡率、全因死亡率和主要不良心脑血管事件（MACCE）。使用逻辑回归和Cox比例风险回归评估所有患者及各性别中无SMuRFs（无SMuRFs状态）与结局之间的关联。 结果：研究人群中约11%的患者没有任何SMuRFs。在12.13[11.99 - 12.36]个月的随访期间，有无SMuRFs的患者在住院死亡率（调整优势比（OR）：1.51，95%置信区间（CI）：0.91 - 2.65，P = 0.108）、全因死亡率[调整风险比（HR）：1.01，95%CI：0.88 - 1.46，P = 0.731]和MACCE（调整HR：0.93，95%CI：0.81 - 1.12，P = 0.412）方面无差异。性别分层分析显示，有SMuRFs和无SMuRFs的男性结局相似。相比之下，无SMuRFs的女性住院死亡率（调整OR：3.28，95%CI：1.92 - 6.21，P < 0.001）和全因死亡率（调整HR：1.41，95%CI：1.02 - 3.21，P = 0.008）显著高于有SMuRFs的女性。 结论：接受PCI的ACS患者中，近十分之一没有SMuRFs。无SMuRFs在住院死亡率、一年死亡率和MACCE方面没有任何益处。更糟糕的是，无SMuRFs的女性在住院和一年死亡率方面存在过高风险。
Front Cardiovasc Med. 2022-7-22
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2021-3
JACC Cardiovasc Interv. 2022-6-13
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