Management and outcomes of patients admitted with type 2 myocardial infarction with and without standard modifiable risk factors

Sokhal, Balamrit Singh; Matetić, Andrija; Paul, Timir K.; Velagapudi, Poonam; Lambrinou, Ekaterini; Figtree, Gemma A.; Rashid, Muhammad; Moledina, Saadiq; Vassiliou, Vassilios; Mallen, Christian; Mamas, Mamas A.

doi:10.1016/j.ijcard.2022.09.037

Cited by 5 publications

(5 citation statements)

References 23 publications

(60 reference statements)

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“…MACCE, Major adverse cardio-cerebrovascular events. cancer, liver, autoimmune, or inflammatory diseases (22,33). It is also worth mentioning that despite having no traditional risk factors, SMuRF-less patients had experienced the ACS episode, implying that these patients possess a highly susceptible atherosclerotic substrate independent of the central atherosclerosis risk factors.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, SMuRF-less patients might comprise a group with missed diagnosis of traditional risk factors or those having continuous values of SMuRFs just below the usual thresholds (for example pre-diabetic patients). This group might also encompass patients with atypical or other risk factors, such as cancer, liver, autoimmune, or inflammatory diseases ( 22 , 33 ). It is also worth mentioning that despite having no traditional risk factors, SMuRF-less patients had experienced the ACS episode, implying that these patients possess a highly susceptible atherosclerotic substrate independent of the central atherosclerosis risk factors.…”

Section: Discussionmentioning

confidence: 99%

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In-hospital and 1-year outcomes of patients without modifiable risk factors presenting with acute coronary syndrome undergoing PCI: a Sex-stratified analysis

Sheikhy,

Fallahzadeh,

Jameie

et al. 2023

Front. Cardiovasc. Med.

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AimA considerable proportion of patients admitted with acute coronary syndrome (ACS) have no standard modifiable cardiovascular risk factors (SMuRFs: hypertension, diabetes mellitus, dyslipidemia, and cigarette smoking). The outcomes of this population following percutaneous coronary intervention (PCI) are debated. Further, sex differences within this population have yet to be established.MethodsThis retrospective cohort study included 7,847 patients with ACS who underwent PCI. The study outcomes were in-hospital mortality, all-cause mortality, and major adverse cardio-cerebrovascular events (MACCE). The association between the absence of SMuRFs (SMuRF-less status) and outcomes among all the patients and each sex was assessed using logistic and Cox proportional hazard regressions.ResultsApproximately 11% of the study population had none of the SMuRFs. During 12.13 [11.99–12.36] months of follow-up, in-hospital mortality (adjusted-odds ratio (OR):1.51, 95%confidence interval (CI): 0.91–2.65, P:0.108), all-cause mortality [adjusted-hazard ratio (HR): 1.01, 95%CI: 0.88–1.46, P: 0.731], and MACCE (adjusted-HR: 0.93, 95%CI:0.81–1.12, P: 0.412) did not differ between patients with and without SMuRFs. Sex-stratified analyses recapitulated similar outcomes between SMuRF+ and SMuRF-less men. In contrast, SMuRF-less women had significantly higher in-hospital (adjusted-OR: 3.28, 95%CI: 1.92–6.21, P < 0.001) and all-cause mortality (adjusted-HR:1.41, 95%CI: 1.02–3.21, P: 0.008) than SMuRF+ women.ConclusionsAlmost one in 10 patients with ACS who underwent PCI had no SMuRFs. The absence of SMuRFs did not confer any benefit in terms of in-hospital mortality, one-year mortality, and MACCE. Even worse, SMuRF-less women paradoxically had an excessive risk of in-hospital and one-year mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

In-hospital and 1-year outcomes of patients without modifiable risk factors presenting with acute coronary syndrome undergoing PCI: a Sex-stratified analysis

Sheikhy,

Fallahzadeh,

Jameie

et al. 2023

Front. Cardiovasc. Med.

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“…In most studies, classical CV risk factors are frequently associated with T2MI and CAD [29]. Beyond these classical risk factors, non-conventional risk factors such as depression can also contribute to the pathogenesis of CAD, particularly in T2MI [30].…”

Section: Prevalence and Severity Of Cad In T2mi Based On Coronary Ang...mentioning

confidence: 99%

Coronary Artery Disease: A Key Issue in Type 2 Myocardial Infarction: Systematic Review and Recent Findings

Yao,

Zeller,

N’Guetta

et al. 2023

JCM

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Underlying coronary artery disease (CAD) is increasingly considered to be a key issue in the pathophysiology of type 2 myocardial infarction (T2MI). In T2MI, which is attributable to a mismatch between oxygen supply/demand, CAD is common and appears to be more severe than in type 1 myocardial infarction (T1MI). Little is known about the heterogeneous mechanisms that cause supply/demand imbalance and non-coronary triggers leading to myocardial ischemia or about how they are potentially modulated by the presence and severity of CAD. CAD seems to be underrecognized and undertreated in T2MI, even though previous studies have demonstrated both the short and long-term prognostic value of CAD in T2MI. In this literature review, we attempt to address the prevalence and severity of CAD, challenges in the discrimination between T2MI and T1MI in the presence of CAD, and the prognostic value of CAD among patients with T2MI.

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“…Nonetheless, individuals who present with acute coronary syndrome (ACS) without SMuRFs (SMuRF-less) represent a growing and relevant (25 %) proportion of the ACS population [3] . Recent evidence suggests that SMuRF-less patients may be at increased risk of adverse event following ACS [4] , [5] , [6] , [7] . The primary explanation underpinning the emerging prevalence of SMuRF-less patients is likely to be that our community success in reducing traditional risk factors has unmasked the challenging issue of how to advise those without known modifiable risk factors.…”

Section: Introductionmentioning

confidence: 99%

Impact of the number of modifiable risk factors on clinical outcomes after percutaneous coronary intervention: An analysis from the e-Ultimaster registry

Kobo,

Levi,

Abu-Fanne

et al. 2024

IJC Heart & Vasculature

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Management and outcomes of patients admitted with type 2 myocardial infarction with and without standard modifiable risk factors

Cited by 5 publications

References 23 publications

In-hospital and 1-year outcomes of patients without modifiable risk factors presenting with acute coronary syndrome undergoing PCI: a Sex-stratified analysis

In-hospital and 1-year outcomes of patients without modifiable risk factors presenting with acute coronary syndrome undergoing PCI: a Sex-stratified analysis

Coronary Artery Disease: A Key Issue in Type 2 Myocardial Infarction: Systematic Review and Recent Findings

Impact of the number of modifiable risk factors on clinical outcomes after percutaneous coronary intervention: An analysis from the e-Ultimaster registry

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