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Cardiovascular Outcomes of ST-Elevation Myocardial Infarction (STEMI) Patients without Standard Modifiable Risk Factors (SMuRF-Less): The Intermountain Healthcare Experience

Studies primarily outside the United States have reported that SMuRF-less STEMI patients are surprisingly common (14–27%) and have a worse in-hospital/short-term prognosis. Given potential demographic and management differences over time and in the US, we aimed to identify the proportion and outcome...

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Autores principales: Anderson, Jeffrey L., Knight, Stacey, May, Heidi T., Le, Viet T., Almajed, Jawad, Bair, Tami L., Knowlton, Kirk U., Muhlestein, Joseph B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9821748/
https://www.ncbi.nlm.nih.gov/pubmed/36614876
http://dx.doi.org/10.3390/jcm12010075
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author Anderson, Jeffrey L.
Knight, Stacey
May, Heidi T.
Le, Viet T.
Almajed, Jawad
Bair, Tami L.
Knowlton, Kirk U.
Muhlestein, Joseph B.
author_facet Anderson, Jeffrey L.
Knight, Stacey
May, Heidi T.
Le, Viet T.
Almajed, Jawad
Bair, Tami L.
Knowlton, Kirk U.
Muhlestein, Joseph B.
author_sort Anderson, Jeffrey L.
collection PubMed
description Studies primarily outside the United States have reported that SMuRF-less STEMI patients are surprisingly common (14–27%) and have a worse in-hospital/short-term prognosis. Given potential demographic and management differences over time and in the US, we aimed to identify the proportion and outcomes of SMuRF-less STEMI patients in a large US healthcare population. Patients with a first STEMI presenting to Intermountain Healthcare catheterization laboratories between 2001–2021 were included. SMuRF included a clinical diagnosis of, or treatment for, hypertension, hyperlipidemia, diabetes, and smoking. Follow-up MACE were defined as death, MI, and heart failure hospitalization (HFH) by 60 days and long-term. Qualifying STEMI patients totaled 3510, 26.2% (919) with no SMuRF. SMuRF-less patients were younger, more frequently male, and had fewer comorbidities. Neither total MACE (adj HR 0.95, p = 0.72) nor death (adj HR 1.06, p = 0.69) differed by SMuRF status at 60 days. Long-term outcomes were more frequent in SMuRF patients, which remained significant for total MACE (adj HR 0.83, p = 0.02) and HFH (HR 0.36, p = 0.0005) after adjustment for baseline differences other than SMuRF. Results were consistent through subgroup and sensitivity analyses. In this moderately large US healthcare population, SMuRF-less STEMI presentation was confirmed to be common (26.2%). However, unlike earlier, mostly non-US reports, adjusted short-term outcomes were similar, and long-term outcomes were more favorable. Further studies to increase understanding, recognition, and treatment of risk factors in SMuRF-less subjects and to optimize STEMI management are indicated.
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spelling pubmed-98217482023-01-07 Cardiovascular Outcomes of ST-Elevation Myocardial Infarction (STEMI) Patients without Standard Modifiable Risk Factors (SMuRF-Less): The Intermountain Healthcare Experience Anderson, Jeffrey L. Knight, Stacey May, Heidi T. Le, Viet T. Almajed, Jawad Bair, Tami L. Knowlton, Kirk U. Muhlestein, Joseph B. J Clin Med Article Studies primarily outside the United States have reported that SMuRF-less STEMI patients are surprisingly common (14–27%) and have a worse in-hospital/short-term prognosis. Given potential demographic and management differences over time and in the US, we aimed to identify the proportion and outcomes of SMuRF-less STEMI patients in a large US healthcare population. Patients with a first STEMI presenting to Intermountain Healthcare catheterization laboratories between 2001–2021 were included. SMuRF included a clinical diagnosis of, or treatment for, hypertension, hyperlipidemia, diabetes, and smoking. Follow-up MACE were defined as death, MI, and heart failure hospitalization (HFH) by 60 days and long-term. Qualifying STEMI patients totaled 3510, 26.2% (919) with no SMuRF. SMuRF-less patients were younger, more frequently male, and had fewer comorbidities. Neither total MACE (adj HR 0.95, p = 0.72) nor death (adj HR 1.06, p = 0.69) differed by SMuRF status at 60 days. Long-term outcomes were more frequent in SMuRF patients, which remained significant for total MACE (adj HR 0.83, p = 0.02) and HFH (HR 0.36, p = 0.0005) after adjustment for baseline differences other than SMuRF. Results were consistent through subgroup and sensitivity analyses. In this moderately large US healthcare population, SMuRF-less STEMI presentation was confirmed to be common (26.2%). However, unlike earlier, mostly non-US reports, adjusted short-term outcomes were similar, and long-term outcomes were more favorable. Further studies to increase understanding, recognition, and treatment of risk factors in SMuRF-less subjects and to optimize STEMI management are indicated. MDPI 2022-12-22 /pmc/articles/PMC9821748/ /pubmed/36614876 http://dx.doi.org/10.3390/jcm12010075 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Anderson, Jeffrey L.
Knight, Stacey
May, Heidi T.
Le, Viet T.
Almajed, Jawad
Bair, Tami L.
Knowlton, Kirk U.
Muhlestein, Joseph B.
Cardiovascular Outcomes of ST-Elevation Myocardial Infarction (STEMI) Patients without Standard Modifiable Risk Factors (SMuRF-Less): The Intermountain Healthcare Experience
title Cardiovascular Outcomes of ST-Elevation Myocardial Infarction (STEMI) Patients without Standard Modifiable Risk Factors (SMuRF-Less): The Intermountain Healthcare Experience
title_full Cardiovascular Outcomes of ST-Elevation Myocardial Infarction (STEMI) Patients without Standard Modifiable Risk Factors (SMuRF-Less): The Intermountain Healthcare Experience
title_fullStr Cardiovascular Outcomes of ST-Elevation Myocardial Infarction (STEMI) Patients without Standard Modifiable Risk Factors (SMuRF-Less): The Intermountain Healthcare Experience
title_full_unstemmed Cardiovascular Outcomes of ST-Elevation Myocardial Infarction (STEMI) Patients without Standard Modifiable Risk Factors (SMuRF-Less): The Intermountain Healthcare Experience
title_short Cardiovascular Outcomes of ST-Elevation Myocardial Infarction (STEMI) Patients without Standard Modifiable Risk Factors (SMuRF-Less): The Intermountain Healthcare Experience
title_sort cardiovascular outcomes of st-elevation myocardial infarction (stemi) patients without standard modifiable risk factors (smurf-less): the intermountain healthcare experience
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9821748/
https://www.ncbi.nlm.nih.gov/pubmed/36614876
http://dx.doi.org/10.3390/jcm12010075
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