Cardiology Department, AP-HP, Hôpital Bichat, 46 Rue Henri Huchard, 75018 Paris, France.
Université Paris-Cité, INSERM U1148, FACT (French Alliance for Cardiovascular Trials), 46 Rue Henri Huchard, 75018 Paris, France.
Eur Heart J. 2024 Jul 12;45(27):2396-2406. doi: 10.1093/eurheartj/ehae299.
It has been reported that patients without standard modifiable cardiovascular (CV) risk factors (SMuRFs-diabetes, dyslipidaemia, hypertension, and smoking) presenting with first myocardial infarction (MI), especially women, have a higher in-hospital mortality than patients with risk factors, and possibly a lower long-term risk provided they survive the post-infarct period. This study aims to explore the long-term outcomes of SMuRF-less patients with stable coronary artery disease (CAD).
CLARIFY is an observational cohort of 32 703 outpatients with stable CAD enrolled between 2009 and 2010 in 45 countries. The baseline characteristics and clinical outcomes of patients with and without SMuRFs were compared. The primary outcome was a composite of 5-year CV death or non-fatal MI. Secondary outcomes were 5-year all-cause mortality and major adverse cardiovascular events (MACE-CV death, non-fatal MI, or non-fatal stroke).
Among 22 132 patients with complete risk factor and outcome information, 977 (4.4%) were SMuRF-less. Age, sex, and time since CAD diagnosis were similar across groups. SMuRF-less patients had a lower 5-year rate of CV death or non-fatal MI (5.43% [95% CI 4.08-7.19] vs. 7.68% [95% CI 7.30-8.08], P = 0.012), all-cause mortality, and MACE. Similar results were found after adjustments. Clinical event rates increased steadily with the number of SMuRFs. The benefit of SMuRF-less status was particularly pronounced in women.
SMuRF-less patients with stable CAD have a substantial but significantly lower 5-year rate of CV death or non-fatal MI than patients with risk factors. The risk of CV outcomes increases steadily with the number of risk factors.
据报道，首次心肌梗死（MI）且无标准可调节心血管（CV）危险因素（SMuRFs-糖尿病、血脂异常、高血压和吸烟）的患者，尤其是女性，其住院死亡率高于有危险因素的患者，但如果他们能在梗死后存活下来，其长期风险可能较低。本研究旨在探讨无 SMuRFs 的稳定型冠状动脉疾病（CAD）患者的长期结局。
CLARIFY 是一项观察性队列研究，纳入了 2009 年至 2010 年间 45 个国家的 32703 例稳定型 CAD 门诊患者。比较了有和无 SMuRFs 的患者的基线特征和临床结局。主要结局为 5 年 CV 死亡或非致死性 MI 的复合结局。次要结局为 5 年全因死亡率和主要不良心血管事件（MACE-CV 死亡、非致死性 MI 或非致死性卒中等）。
在有完整危险因素和结局信息的 22132 例患者中，有 977 例（4.4%）为无 SMuRFs。各组之间的年龄、性别和 CAD 诊断后时间相似。无 SMuRFs 的患者 5 年 CV 死亡或非致死性 MI 的发生率较低（5.43%[95%CI 4.08-7.19] vs. 7.68%[95%CI 7.30-8.08]，P=0.012），全因死亡率和 MACE 也较低。调整后也得到了相似的结果。临床事件发生率随 SMuRFs 数量的增加而稳步上升。无 SMuRFs 状态的获益在女性中尤为明显。
稳定型 CAD 且无 SMuRFs 的患者 5 年 CV 死亡或非致死性 MI 的发生率明显低于有危险因素的患者。CV 结局风险随危险因素数量的增加而稳步上升。
