The Neglected Population of Stemi Without Standard Modifiable Cardiovascular Risk Factors. Insights From a Prospective Single Centre Stemi Registry

Gnanaraj, Justin Paul; Iliyas, Mohamed; Sethupathy, Suriyakanth; Saravanan, Siva Subramaniyam; Kurian, Sijoy; Subramanian, Srinivas; Saminathan, Karthikaa; Sankaran, S.; Polavarapu, Anurag; Mohandoss, Nageswaran Piskala; Ravishankar, G.; Bharath, T; Dharmaraj, G.; Prabhu, Salai Sudhan

doi:10.1016/s0735-1097(21)01569-2

Cited by 5 publications

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“…The proportion of SMuRFless ACS patients from western parts of the world showed 17% in Sweden [ 5 ], 16% in Australia [ 4 ], and 23% of patients in England [ 11 ]. The limited data from Asia is inconsistent and the proportion of SMuRFless patients ranged from as high as 20.8% of STEMI patients in India [ 12 ] to 8.3% of STEMI being SMuRFless in Singapore [ 6 ]. We found 18% of STEMI patients to be SMuRFless.…”

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confidence: 99%

Clinical characteristics, management, and 5-year survival compared between no standard modifiable risk factor (SMuRFless) and ≥ 1 SMuRF ACS cases: an analysis of 15,051 cases from Pakistan

Sheikh

Peerwani

Hanif

et al. 2023

BMC Cardiovasc Disord

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Background There has been an increase in Acute Coronary Syndrome (ACS) patients without standard modifiable risk factors i.e. hypertension, diabetes, dyslipidemia, and tobacco use (SMuRFless) compared to the patients with ≥ 1 SMuRF but this has not been studied in South Asia despite them being a high-risk population. We conducted a comparative analysis of first episodes of ACS cases admitted to a tertiary cardiac center in Pakistan between SMuRFless and ≥ 1 SMuRF patients for clinical presentation, management, in-hospital, and 5-year mortality. Methods We undertook a retrospective study and data of 15,051 patients admitted at Tabba Heart Institute (THI) with the first episode of ACS was extracted from Chest Pain-MI™, and the CathPCI Registry® registry affiliated with the National Cardiovascular Data Registry (NCDR®), USA. Logistic regression and Cox proportional algorithm yielded odds ratio (OR) and hazard ratios (HR) with 95% confidence interval (CI) for associated factors of in-patient and 5-year mortality. Results There were 15% SMuRFless cases and in-hospital mortality was 4.1% in SMuRFless vs. 3.9% in the ≥ 1 SMuRF group (p-0.59), the difference remained insignificant after adjusting for age, gender, Killip class, multivessel disease, type of ACS, percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) (Adjusted OR:1.1 [0.8, 1.3]. Unadjusted 5-year mortality was 40% lower in the SMuRFless group but the difference was insignificant after adjusting for age, gender, disease at presentation, its severity, and management (Adjusted HR 0.7 95% CI[0.5, 1.0]). STEMI, NSTEMI, Killip class, and multivessel disease increased the risk of overall 5-year mortality. Conclusion In-hospital and 5-year mortality was not different between the SMuRFless and ≥ 1 SMuRF group, there is a need to understand mediators of immediate and long-term mortality risk in SMuRFless patients.

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