Yang Yuxiu, Gao Fei, Liu Tao, Deng Jianping, Qiu Hong, Ma Xiaoteng, Yang Lixia, Wang Zhijian
Department of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Cardiovascular Disease, Beijing, China.
Department of Cardiology, Beijing Anzhen Nanchong Hospital, Capital Medical University, Nanchong, Sichuan, China.
J Cardiol. 2025 May 20. doi: 10.1016/j.jjcc.2025.04.016.
Individuals who present with acute myocardial infarction (AMI) in the absence of standard modifiable cardiovascular risk factors (i.e. 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 nutritional status.
We consecutively included patients from a multi-center, prospective registry (NCT05337319) from January 2022 to October 2023. Malnutrition was defined via the Nutritional Risk Index. The primary outcome was in-hospital major adverse cardiovascular events (MACEs), which included mortality, cardiac shock, acute congestive heart failure, reinfarction, and stroke.
A total of 3753 patients with first-presentation AMI were included, of which 10 % were SMuRF-less and over 21 % were malnourished. SMuRF-less malnourished had the highest MACEs (16.1 %), followed by the SMuRF-less nourished (15.5 %), ≥1 SMuRFs malnourished (12.1 %), and ≥1 SMuRFs nourished (5.2 %, p < 0.001). With ≥1 SMuRFs nourished as the reference, SMuRF-less malnourished had the highest increase in MACEs [adjusted OR (95 % CI), 3.385 (2.163-5.298), p < 0.001], followed by SMuRF-less nourished group [adjusted OR (95 % CI), 2.460 (1.214-4.985), p = 0.012], but only a nonsignificant increase in MACEs was observed in the ≥1 SMuRFs malnourished [adjusted OR (95 % CI), 1.297 (0.880-1.911), p = 0.188]. SMuRF-less was not associated with MACEs in the subgroup of malnourished patients [adjusted OR (95 % CI), 1.931 (0.892-4.178), p = 0.095], with a nonsignificant result in interaction analysis (p for interaction = 0.148).
Among patients with first-presentation AMI, malnutrition is prevalent, especially in those SMuRF-less. Compared with those with at least one SMuRF, SMuRF-less patients have a significantly higher risk of in-hospital MACEs irrespective of their nutritional status, while the outcome was the most favorable among ≥1 SMuRF and nourished patients.
在没有标准可改变心血管危险因素（即无标准可改变心血管危险因素，SMuRF-less）的情况下出现急性心肌梗死（AMI）的个体似乎死亡风险显著增加；然而，“SMuRF悖论”是否会受到患者基线营养状况的影响仍不清楚。
我们连续纳入了2022年1月至2023年10月来自多中心前瞻性登记处（NCT05337319）的患者。通过营养风险指数定义营养不良。主要结局是住院期间主要不良心血管事件（MACE），包括死亡、心源性休克、急性充血性心力衰竭、再梗死和中风。
共纳入3753例首次发生AMI的患者，其中10%为无标准可改变心血管危险因素且营养不良，超过21%为营养不良。无标准可改变心血管危险因素且营养不良的患者发生MACE的比例最高（16.1%），其次是无标准可改变心血管危险因素且营养良好的患者（15.5%）、有≥1个标准可改变心血管危险因素且营养不良的患者（12.1%）和有≥1个标准可改变心血管危险因素且营养良好的患者（5.2%，p<0.001）。以有≥1个标准可改变心血管危险因素且营养良好的患者作为参照，无标准可改变心血管危险因素且营养不良的患者MACE增加最多[调整后比值比（95%置信区间），3.385（2.163 - 5.298），p<0.001]，其次是无标准可改变心血管危险因素且营养良好的组[调整后比值比（95%置信区间），2.460（1.214 - 4.985），p = 0.012]，但有≥1个标准可改变心血管危险因素且营养不良的患者MACE仅出现非显著增加[调整后比值比（95%置信区间），1.297（0.880 - 1.911），p = 0.188]。在营养不良患者亚组中，无标准可改变心血管危险因素与MACE无关[调整后比值比（95%置信区间），1.931（0.892 - 4.178），p = 0.095]，交互分析结果不显著（交互作用p值 = 0.148）。
在首次发生AMI的患者中，营养不良很普遍，尤其是在那些无标准可改变心血管危险因素的患者中。与至少有一个标准可改变心血管危险因素的患者相比，无标准可改变心血管危险因素的患者无论营养状况如何，住院期间发生MACE的风险都显著更高，而在有≥1个标准可改变心血管危险因素且营养良好的患者中结局最有利。
