Affiliation:
1. Medical School The University of Western Australia Perth Western Australia Australia
2. Department of Cardiology Fiona Stanley Hospital Perth Western Australia Australia
3. School of Population Health Curtin University Perth Western Australia Australia
4. School of Public Health and Preventive Medicine Monash University Victoria Melbourne Australia
5. Harry Perkins Institute of Medical Research Perth Western Australia Australia
6. Faculty of Medicine and Health University of Sydney Sydney New South Wales Australia
7. Kolling Institute of Medical Research Royal North Shore Hospital Sydney New South Wales Australia
8. Department of Cardiology Alfred Hospital Melbourne Victoria Australia
9. Medical School Curtin University Perth Western Australia Australia
Abstract
AbstractBackgroundAmong ST‐elevation myocardial infarction (STEMI) patients, those with no standard modifiable risk factors (SMuRFs: hypertension, diabetes mellitus, hypercholesterolemia, and smoking) have higher 30‐day mortality than those with SMuRFs. Differences in coronary lesion characteristics remain unclear.MethodsData from STEMI patients aged ≤60 years from the Asia Pacific Evaluation of Cardiovascular Therapies Network (Australia, Hong Kong, Malaysia, Singapore, and Vietnam) was retrospectively analysed. Exclusion criteria included incomplete SMuRF data, prior myocardial infarction, or prior coronary revascularisation. Lesion type was defined using the American College of Cardiology criteria. Major adverse cardiovascular events (MACE) were defined as peri‐procedural myocardial infarction, emergency coronary artery bypass surgery, cerebrovascular event, or mortality. Multiple logistic regressions were used.ResultsOf 4404 patients, 767 (17.4%) were SMuRFless. SMuRFless patients were more frequently younger (median age 51 vs. 53 years; p < 0.001), female (22.6% vs. 15.5%; p < 0.001), thrombolysed (20.1% vs. 12.5%; p < 0.001), and in cardiogenic shock (11.2% vs. 8.6%; p = 0.020). SMuRFless patients had significantly higher in‐hospital MACE (7.2% vs. 4.3%; adjusted odds ratio [aOR] 2.25; 95% confidence interval [CI] 1.24–4.08; p = 0.008) but 1‐year mortality was not significantly different (3.6% vs. 5.7%, aOR 0.58; 95% CI 0.06–6.12; p = 0.549). Compared with patients with SMuRFs (4918 lesions), the SMuRFless (940 lesions) had fewer type B2/C lesions (60.8% vs. 65.6%; p = 0.020) and fewer lesions ≥20 mm (51.1% vs. 57.1%; p = 0.002) but more procedural complications (5.1% vs. 2.7%; p < 0.001).ConclusionsAmong young STEMI patients, the SMuRFless have shorter and less complex lesions, but worse procedural and short‐term MACE outcomes.