Higher mortality encountered among ACS patients without standard modifiable CV risk factors

SINGAPORE: In contrast to patients with at least one conventional atherosclerotic risk factor, ACS patients without standard modifiable cardiovascular risk factors (SMuRF) show increased mortality, according to research in the International Journal of Cardiology.

The biggest cause of death worldwide is heart disease, which includes acute coronary syndromes (ACS). In order for prompt treatment to be effective, patients must be adequately classified based on their risk of developing ACS. For risk stratification in acute coronary syndrome, standard modifiable cardiovascular risk factors (SMuRF), which include hypertension, hyperlipidemia, and smoking (ACS) are often employed. A growing number of ACS patients, according to recent studies, lack SMuRF.

To ascertain the percentage of SMuRF-less individuals in the ACS cohort, the researchers performed single-arm analyses and compared the clinical presentation and outcomes of these patients.

Studies comparing SMuRF-less and SMuRF patients with initial presentations of ACS were sought after using PubMed, Embase, and Medline. From 15 investigations, 1,285,722 patients in total were assessed.

Conclusive point of the study:

• 11.56 percent lacked SMuRF.
• 7.44% of non-ST-segment-elevation ACS patients and 12.87% of ST-segment-elevation myocardial infarction (STEMI) patients did not have SMuRFs.
• In comparison to patients with SMuRFs (49.21%), more patients without SMuRFs (60.71%) presented with STEMI.
• Even after having a lower body mass index and lesser comorbid conditions like chronic kidney disease, peripheral arterial disease, stroke, and heart failure, SMuRF-less patients had higher in-hospital mortality (RR: 1.57, 95%CI:1.38 to 1.80) and cardiogenic shock (RR: 1.39, 95%CI:1.18 to 1.65), but a reduced risk of heart failure (RR: 0.91, 95%CI:0.83 to 0.99).
• SMuRF-less patients were given less statins (RR:0.93, 95%CI:0.91 to 0.95), beta-blockers (RR:0.94, 95%CI:0.92 to 0.96), P2Y12 inhibitors (RR: 0.98, 95%CI: 0.96 to 0.99), and ACEIs or ARBs (RR:0.92, 95%CI:0.75 to 0.91) upon discharge.

The researchers concluded that SMuRF-less individuals had higher in-hospital mortality and cardiogenic shock despite having less comorbidities.

"In patients without SMuRF, medicinal therapy indicated by guidelines is underutilized, which is alarming. The next crucial step is to unravel novel risk variables among people lacking SMuRF "they added.

REFERENCE

Kong G, Chin YH, Chong B, Goh RSJ, Lim OZH, Ng CH, Muthiah M, Foo R, Vernon ST, Loh PH, Chan MY, Chew NWS, Figtree GA. Higher mortality in acute coronary syndrome patients without standard modifiable risk factors: Results from a global meta-analysis of 1,285,722 patients. Int J Cardiol. 2022 Sep 27:S0167-5273(22)01413-9. doi: 10.1016/j.ijcard.2022.09.062. Epub ahead of print. PMID: 36179904.