Medical School, The University of Western Australia, Perth, Western Australia, Australia.
Department of Cardiology, Fiona Stanley Hospital, Perth, Western Australia, Australia.
Catheter Cardiovasc Interv. 2024 Oct;104(4):714-722. doi: 10.1002/ccd.31205. Epub 2024 Sep 9.
Among ST-elevation myocardial infarction (STEMI) patients, those with no standard modifiable risk factors (SMuRFs: hypertension, diabetes mellitus, hypercholesterolemia, and smoking) have higher 30-day mortality than those with SMuRFs. Differences in coronary lesion characteristics remain unclear.
Data from STEMI patients aged ≤60 years from the Asia Pacific Evaluation of Cardiovascular Therapies Network (Australia, Hong Kong, Malaysia, Singapore, and Vietnam) was retrospectively analysed. Exclusion criteria included incomplete SMuRF data, prior myocardial infarction, or prior coronary revascularisation. Lesion type was defined using the American College of Cardiology criteria. Major adverse cardiovascular events (MACE) were defined as peri-procedural myocardial infarction, emergency coronary artery bypass surgery, cerebrovascular event, or mortality. Multiple logistic regressions were used.
Of 4404 patients, 767 (17.4%) were SMuRFless. SMuRFless patients were more frequently younger (median age 51 vs. 53 years; p < 0.001), female (22.6% vs. 15.5%; p < 0.001), thrombolysed (20.1% vs. 12.5%; p < 0.001), and in cardiogenic shock (11.2% vs. 8.6%; p = 0.020). SMuRFless patients had significantly higher in-hospital MACE (7.2% vs. 4.3%; adjusted odds ratio [aOR] 2.25; 95% confidence interval [CI] 1.24-4.08; p = 0.008) but 1-year mortality was not significantly different (3.6% vs. 5.7%, aOR 0.58; 95% CI 0.06-6.12; p = 0.549). Compared with patients with SMuRFs (4918 lesions), the SMuRFless (940 lesions) had fewer type B2/C lesions (60.8% vs. 65.6%; p = 0.020) and fewer lesions ≥20 mm (51.1% vs. 57.1%; p = 0.002) but more procedural complications (5.1% vs. 2.7%; p < 0.001).
Among young STEMI patients, the SMuRFless have shorter and less complex lesions, but worse procedural and short-term MACE outcomes.
在 ST 段抬高型心肌梗死（STEMI）患者中，无标准可修正风险因素（SMuRFs：高血压、糖尿病、高脂血症和吸烟）的患者 30 天死亡率高于有 SMuRFs 的患者。冠状动脉病变特征的差异仍不清楚。
回顾性分析来自亚太心血管治疗评估网络（澳大利亚、中国香港、马来西亚、新加坡和越南）的年龄≤60 岁 STEMI 患者的数据。排除标准包括 SMuRF 数据不完整、既往心肌梗死或冠状动脉血运重建。病变类型采用美国心脏病学会标准定义。主要不良心血管事件（MACE）定义为围手术期心肌梗死、紧急冠状动脉旁路移植术、脑血管事件或死亡。采用多变量逻辑回归。
在 4404 例患者中，767 例（17.4%）为 SMuRFless。SMuRFless 患者更年轻（中位数年龄 51 岁 vs. 53 岁；p<0.001）、女性（22.6% vs. 15.5%；p<0.001）、溶栓（20.1% vs. 12.5%；p<0.001）和心源性休克（11.2% vs. 8.6%；p=0.020）的发生率更高。SMuRFless 患者院内 MACE 发生率显著更高（7.2% vs. 4.3%；调整后的优势比 [aOR] 2.25；95%置信区间 [CI] 1.24-4.08；p=0.008），但 1 年死亡率无显著差异（3.6% vs. 5.7%，aOR 0.58；95%CI 0.06-6.12；p=0.549）。与有 SMuRFs 的患者（4918 个病变）相比，SMuRFless 的患者（940 个病变）B2/C 型病变更少（60.8% vs. 65.6%；p=0.020），病变长度≥20mm 的病变更少（51.1% vs. 57.1%；p=0.002），但手术并发症更多（5.1% vs. 2.7%；p<0.001）。
在年轻的 STEMI 患者中，SMuRFless 患者的病变更短、更简单，但手术和短期 MACE 结局更差。
