Anand Vickram Vijay, Koh Jaycie, Teo Tobias, Chin Yip Han, Mahesh Rishabh, Chan Mark Y, Figtree Gemma A, Chew Nicholas W S
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore.
Clin Res Cardiol. 2025 Jun;114(6):681-689. doi: 10.1007/s00392-024-02563-7. Epub 2024 Nov 12.
This meta-analysis investigates the sex differences in mortality risk between the acute coronary syndrome (ACS) population without standard modifiable risk factors (SMuRF-less) and those with at least one standard modifiable risk factor (SMuRF), and analyses mortality rates between males and females within the SMuRF-less cohort.
The MEDLINE and Embase databases were searched for cohort studies with sex-stratified outcomes for SMuRF-less versus SMuRF patients with ACS till 15 December 2023. The analysis of variables reported in proportions was carried out by utilizing a meta-analysis with a generalized linear mixed model while continuous variables were analyzed by a meta-analysis of means, using an inverse variance method.
Eight studies were included in the current paper, with 82,395 SMuRF-less ACS patients and 607,558 SMuRF ACS patients. Excess in-hospital mortality found in SMuRF-less ACS, compared to those with SMuRFs, were only observed in females (RR 1.56, 95%CI 1.08-2.25, p = 0.029), but not in males (RR 1.59, 95%CI 0.90-2.80, p = 0.088). On longer follow-up, the 1- and 2-year post-ACS mortality rates were similar across the SMuRF-less and SMuRF cohorts, for both sexes. The subgroup analysis of SMuRF-less ACS individuals revealed that SMuRF-less females had higher in-hospital (RR 1.52, 95%CI 1.30-1.78, p = 0.002), 1-year (RR 1.51, 95%CI 1.34-1.71, p = 0.005) and 2-year mortality risks (RR 1.40, 95%CI 1.13-1.75, p = 0.016) compared to the SMuRF-less male counterparts.
Paradoxical excess mortality in SMuRF-less ACS, compared to those with SMuRFs, was only observed in females. Females without cardiovascular risk factors are at the highest risk of short- and medium-term mortality following ACS.
本荟萃分析旨在研究无标准可改变风险因素（无SMuRF）的急性冠状动脉综合征（ACS）人群与至少有一个标准可改变风险因素（有SMuRF）的人群在死亡风险上的性别差异，并分析无SMuRF队列中男性和女性的死亡率。
检索MEDLINE和Embase数据库，查找截至2023年12月15日的关于无SMuRF与有SMuRF的ACS患者性别分层结局的队列研究。对于以比例报告的变量，采用广义线性混合模型的荟萃分析进行分析；对于连续变量，采用均值荟萃分析，使用逆方差法进行分析。
本文纳入了8项研究，其中无SMuRF的ACS患者82395例，有SMuRF的ACS患者607558例。与有SMuRF的患者相比，无SMuRF的ACS患者中仅女性存在院内死亡过量（RR 1.56，95%CI 1.08 - 2.25，p = 0.029），男性则未观察到（RR 1.59，95%CI 0.90 - 2.80，p = 0.088）。在更长时间的随访中，无论男女，无SMuRF和有SMuRF队列的ACS后1年和2年死亡率相似。对无SMuRF的ACS个体进行亚组分析显示，与无SMuRF的男性相比，无SMuRF的女性具有更高的院内死亡率（RR 1.52，95%CI 1.30 - 1.78，p = 0.002）、1年死亡率（RR 1.51，95%CI 1.34 - 1.71，p = 0.005）和2年死亡率风险（RR 1.40，95%CI 1.13 - 1.75，p = 0.016）。
与有SMuRF的患者相比，无SMuRF的ACS患者中仅女性存在反常的死亡过量。无心血管危险因素的女性在ACS后短期和中期死亡风险最高。
