Moysidis Dimitrios V, Giannopoulos Georgios, Anastasiou Vasileios, Daios Stylianos, Papazoglou Andreas S, Liatsos Alexandros C, Spyridonidis Efstathios, Kamperidis Vasileios, Didagelos Matthaios, Tagarakis Georgios, Savopoulos Christos, Kyriakidis Panagiotis, Konstantinidou Sonia, Giannakoulas George, Vassilikos Vassilios, Ziakas Antonios
Third Department of Cardiology, Hippokration General Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece.
First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kyriakidi 1, 54636 Thessaloniki, Greece.
J Clin Med. 2025 Apr 11;14(8):2645. doi: 10.3390/jcm14082645.
The etiology of acute myocardial infarction (AMI) in patients without history of standard modifiable risk factors (SMuRFs) remains unclear. Simultaneously, evidence suggests that mental health status (MHS) contributes to the pathogenesis of AMI and worsens its outcomes. This analysis of the prospective "Beyond-SMuRFs" (NCT05535582) study included 650 consecutive patients with AMI who had available data on self-reported MHS before AMI, calculated by the SF36-Questionnaire mental component summary (MCS). Poor MHS was defined as MCS ≤ 50. Multivariable logistic-regression and Cox-regression analyses were implemented to investigate poor MHS as a potential predictor of SMuRF-less AMIs and compare all-cause mortality based on SMuRF-less and MH status, respectively. Of 650 patients with AMI (mean age 62.6 ± 12.1 years), 288 (44.3%) had MCS ≤ 50 and 128 (19.7%) were SMuRF-less patients. Three out of four SMuRF-less patients reported an MCS ≤ 50 (n = 96, 75%), a significantly higher percentage than the corresponding percentage in patients with SMuRFs (n = 192, 36.8%; < 0.01). The multivariable logistic regression model showed that MCS ≤ 50 was an independent predictor of SMuRF-less AMI [aOR = 0.95; 95% CI (0.94-0.96)]. Time-to-event analysis for all-cause mortality showed that patients with MCS > 50 had lower mortality rates than those with poor MHS (aHR, 3.61 [95% CI, 2.02 to 6.43], < 0.01). Higher risk for all-cause mortality was also observed in SMuRF-less patients with poor MHS compared to patients with at least one SMuRF and good MHS [aHR, 4.52 (95% CI, 0.94-21.73)]. Poor MHS was an independent predictor of the occurrence of SMuRF-less AMI and predictive of higher mortality in patients with and without SMuRFs.
在没有标准可改变风险因素（SMuRFs）病史的急性心肌梗死（AMI）患者中，其病因仍不清楚。同时，有证据表明心理健康状况（MHS）会导致AMI的发病机制并使预后恶化。这项对前瞻性“超越SMuRFs”（NCT05535582）研究的分析纳入了650例连续的AMI患者，这些患者有AMI发作前自我报告的MHS数据，通过SF36问卷心理成分总结（MCS）计算得出。MHS差被定义为MCS≤50。采用多变量逻辑回归和Cox回归分析来研究MHS差作为无SMuRFs的AMI潜在预测因素，并分别比较基于无SMuRFs和MHS状态的全因死亡率。在650例AMI患者（平均年龄62.6±12.1岁）中，288例（44.3%）MCS≤50，128例（19.7%）为无SMuRFs患者。四分之三的无SMuRFs患者报告MCS≤50（n = 96，75%），这一比例显著高于有SMuRFs患者中的相应比例（n = 192，36.8%；P<0.01）。多变量逻辑回归模型显示，MCS≤50是无SMuRFs的AMI的独立预测因素[aOR = 0.95；95%CI（0.94 - 0.96）]。全因死亡率的事件发生时间分析表明，MCS>50的患者死亡率低于MHS差的患者（aHR，3.61[95%CI，2.02至6.43]，P<0.01）。与至少有一个SMuRF且MHS良好的患者相比，无SMuRFs且MHS差的患者全因死亡风险也更高[aHR，4.52（95%CI，0.94 - 21.73）]。MHS差是无SMuRFs的AMI发生的独立预测因素，并且预测有和无SMuRFs患者的死亡率更高。
