Absence of standard modifiable cardiovascular risk factors tied to poor outcomes in type 2 AMI

Among patients with type 2 acute myocardial infarction (AMI), the absence of standard modifiable cardiovascular risk factors (SMuRF) appears to worsen poor outcomes, such as mortality, stroke, and major adverse cardiovascular and cerebrovascular events (MACCE), a new study has found.

The study included 17,595 patients hospitalized for type 2 AMI. Majority (92.4 percent; n=16,250) had SMuRFs, including diabetes mellitus, current smoking, hypertension, or dyslipidaemia; the remaining 7.6 percent (n=1,345) were designated as SMuRF-less. The primary outcomes were all-cause mortality, MACCE, bleeding, and ischaemic stroke.

Crude analysis found that in-hospital all-cause mortality was significantly more common in SMuRF-less patients (5.9 percent vs 3.0 percent; p<0.001), as were MACCEs (7.1 percent vs 3.8 percent; p<0.001), major bleeding (4.5 percent vs 3.8 percent; p=0.046), and ischaemic stroke (1.9 percent vs 0.8 percent; p<0.001).

Multivariable logistic regression analysis confirmed that the absence of SMuRFs was a significant correlate of higher all-cause mortality (adjusted odds ratio [OR], 2.43, 95 percent confidence interval [CI], 1.83–3.23), MACCE (adjusted OR, 2.32, 95 percent CI, 1.79–2.90), and ischaemic stroke (adjusted OR, 2.57, 95 percent CI, 1.56–4.24). Major bleeding was not affected by SMuRF status.

“This analysis reveals that SMuRF-less patients represent a minority of those admitted for T2AMI but are more likely to suffer adverse in-hospital outcomes and are less likely to be managed invasively,” the researchers said. “These findings warrant further studies to improve overall care and outcomes of SMuRF-less patients.”