Prevalence and outcomes of acute coronary syndrome patients with and without standard modifiable risk factors undergoing percutaneous coronary intervention.

Abstract

Background: There is increasing awareness that patients without standard modifiable risk factors (SMuRFs; diabetes, hypercholesterolaemia, hypertension, and smoking) may represent a unique subset of acute coronary syndrome (ACS) patients. Aim: To investigate prevalence and outcomes of SMuRF-less ACS patients compared to those with ≥1 SMuRF undergoing percutaneous coronary intervention (PCI). Methods: We analysed data from 2005 to 2020 using the Melbourne Interventional Group PCI Registry. Patients with a history of coronary artery disease were excluded. The primary outcome was 30-day mortality. Secondary outcomes included in-hospital events and cardiac events at 30 days. Long-term mortality was investigated using Cox-proportional hazards regression. Results: From 1 January 2005 to 31 December 2020, 2,727 of 18,988 (14.4%) patients were SMuRF-less. Mean age was the same for patients with and without SMuRFs (63 years), and fewer females were SMuRF-less (20% vs 25%, p<0.001). SMuRF-less patients were more likely to present with cardiac arrest (6.6% vs 3.9%, p<0.001) and ST-elevation myocardial infarction (59% vs 51%, p<0.001), and were more likely to experience post-procedural cardiogenic shock (4.5% vs 3.6%, p=0.019) and arrhythmia (11.2% vs 9.9%, p=0.029). At 30 days, mortality, myocardial infarction, revascularisation, and major adverse cardiac and cerebrovascular events did not differ between the groups. During follow-up of approximately 7 years, SMuRF-less patients had an adjusted 12% decreased rate of mortality (HR 0.88 [95% CI 0.78, 0.99]). Conclusions: Despite differences in characteristics, no difference in 30-day outcomes was observed between patients with and without SMuRFs. However, SMuRF-less patients had lower hazard for long-term mortality.