不同体重指数下无标准可改变心血管危险因素的急性心肌梗死患者的院内结局：CCC-ACS项目的研究结果
In-Hospital Outcomes in Patients With Acute Myocardial Infarction and No Standard Modifiable Cardiovascular Risk Factors Across Varying Body Mass Index: Findings From the CCC-ACS Project.
作者信息
Yang Yuxiu, Liu Zaiqiang, Gao Fei, Ma Xiaoteng, Liu Jing, Wang Zhijian
机构信息
Department of Cardiology, Center for Geriatric Cardiovascular Disease, Beijing Anzhen Hospital Capital Medical University Beijing China.
Department of Epidemiology and Cardiology, Beijing Anzhen Hospital, Capital Medical University Beijing Institute of Heart, Lung and Blood Vessel Diseases Beijing China.
出版信息
J Am Heart Assoc. 2025 Apr;14(7):e037651. doi: 10.1161/JAHA.124.037651. Epub 2025 Mar 26.
BACKGROUND
Individuals who present with acute myocardial infarction in the absence of standard modifiable cardiovascular risk factors (ie, SMuRF-less) seem to have a significantly increased risk of mortality; however, it remains unclear whether the "SMuRF paradox" would be influenced by patients' baseline body mass index (BMI) status.
METHODS
Using data from the CCC-ACS (Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome) project from November 2014 to July 2019, we analyzed patients with acute myocardial infarction with and without SMuRFs and categorized their BMI as underweight (<18.5 kg/m), normal weight (18.5-24 kg/m), overweight (24-28 kg/m), and obese (>28 kg/m). The primary outcome was in-hospital all-cause mortality. Multivariable logistic regression models were used to estimate BMI-stratified associations between SMuRF-less status and outcomes.
RESULTS
The study included 44 538 patients with first-presentation acute myocardial infarction, of whom 4454 were SMuRF-less. The incidence of SMuRF-lessness declined from 16.2% to 6.5% as BMI increased by category, and it prevailed more frequently among women and older people regardless of their BMI status. Patients who were SMuRF-less had a significant increase in in-hospital mortality than patients with ≥1 SMuRF (adjusted odds ratio [OR], 1.750 [95% CI, 1.057-2.896], <0.001). The highest mortality rate was observed in the group who were SMuRF-less and underweight (3.5%). Considering patients with ≥1 SMuRF and obesity as the reference group, the group who were SMuRF-less underweight exhibited the highest increase in mortality (adjusted OR, 3.854 [95% CI, 2.130-6.973], <0.001).
CONCLUSIONS
Among patients with first-presentation acute myocardial infarction, compared with those with ≥1 SMuRF, patients who were SMuRF-less have a significantly higher risk of in-hospital mortality, especially in those underweight, whereas in-hospital survival was the most favorable among patients with ≥1 SMuRF and obesity.
REGISTRATION
URL: https://www.clinicaltrials.gov; Unique identifier: NCT0230661.
背景
在没有标准可改变心血管危险因素（即无标准可改变危险因素，SMuRF-less）的情况下发生急性心肌梗死的个体，其死亡风险似乎显著增加；然而，“SMuRF悖论”是否会受到患者基线体重指数（BMI）状态的影响仍不清楚。
方法
利用2014年11月至2019年7月中国心血管疾病医疗质量改善项目（CCC-ACS）的数据，我们分析了有无标准可改变危险因素的急性心肌梗死患者，并将他们的BMI分为体重过轻（<18.5kg/m²）、正常体重（18.5-24kg/m²）、超重（24-28kg/m²）和肥胖（>28kg/m²）。主要结局是院内全因死亡率。使用多变量逻辑回归模型来估计无标准可改变危险因素状态与结局之间按BMI分层的关联。
结果
该研究纳入了44538例首次发生急性心肌梗死的患者，其中4454例无标准可改变危险因素。随着BMI分类增加，无标准可改变危险因素的发生率从16.2%降至6.5%，且无论BMI状态如何，在女性和老年人中更为常见。无标准可改变危险因素的患者比有≥1个标准可改变危险因素的患者院内死亡率显著增加（调整后的比值比[OR]，1.750[95%置信区间，1.057-2.896]，P<0.001）。在无标准可改变危险因素且体重过轻的组中观察到最高死亡率（3.5%）。将有≥1个标准可改变危险因素且肥胖的患者作为参照组，无标准可改变危险因素且体重过轻的组死亡率增加最高（调整后的OR，3.854[95%置信区间，2.130-6.973]，P<0.001）。
结论
在首次发生急性心肌梗死的患者中，与有≥1个标准可改变危险因素的患者相比，无标准可改变危险因素的患者院内死亡风险显著更高，尤其是体重过轻的患者，而在有≥1个标准可改变危险因素且肥胖的患者中院内生存率最为有利。
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