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Angiographic severity in acute coronary syndrome patients with and without standard modifiable risk factors
Andreas S Papazoglou1,2, Ioannis T Farmakis1, Stefanos Zafeiropoulos1
1Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Insights
Patients with acute coronary syndrome (ACS) lacking standard modifiable cardiovascular risk factors (SMuRFs) have higher odds of non-obstructive coronary artery disease (CAD) and increased short-term mortality. This highlights a need for tailored prevention strategies.
Area of Science:
- Cardiology
- Cardiovascular Disease Research
- Medical Statistics
Background:
- Standard secondary prevention for coronary artery disease (CAD) focuses on modifiable cardiovascular risk factors (SMuRFs) like diabetes, dyslipidemia, hypertension, and smoking.
- A notable subset of patients with acute coronary syndrome (ACS) presents without these standard SMuRFs.
- The angiographic severity of CAD in SMuRF-less ACS patients remains under-investigated.
Purpose of the Study:
- To investigate the relationship between the absence of SMuRFs and the angiographic severity of CAD in ACS patients.
- To compare the SYNTAX score distribution between ACS patients with and without SMuRFs.
- To evaluate differences in all-cause mortality between these two groups.
Main Methods:
- Analysis of 534 ACS patients undergoing coronary angiography.
- Propensity score matching was used to compare 56 SMuRF-less patients with 166 patients having at least one SMuRF (1:3 ratio).
- Zero-inflated negative binomial regression and survival analysis were employed to assess CAD severity (SYNTAX score) and mortality.
Main Results:
- The median SYNTAX score was similar between SMuRF-less (13.8) and SMuRF-present (14) groups after matching.
- SMuRF-less status was associated with increased odds of a zero SYNTAX score (OR=2.11), indicating non-obstructive CAD.
- SMuRF-less patients exhibited a higher 30-day all-cause mortality risk (HR=3.58), though long-term mortality risk was comparable.
Conclusions:
- In ACS patients, the absence of SMuRFs is linked to a greater likelihood of non-obstructive CAD.
- Patients with ACS and no SMuRFs face increased short-term mortality risks.
- These findings suggest a distinct clinical profile for SMuRF-less ACS patients requiring further investigation.
Background:
Routine coronary artery disease (CAD) secondary prevention strategies target standard modifiable cardiovascular risk factors (SMuRFs), which include: diabetes mellitus, dyslipidemia, hypertension, and smoking. However, a significant proportion of patients with acute coronary syndrome (ACS) present without any SMuRFs. The angiographic severity of disease in this population has not yet been investigated.
Methods:
After propensity score matching of patients without SMuRFs and patients with ≥1 SMuRFs (ratio 1:3), we used zero-inflated negative binomial regression modeling to investigate the relationship of SMuRF-less status with the angiographic severity of CAD, as measured by the SYNTAX score. Survival analysis was performed to investigate differences in all-cause mortality at 30 days and at the end of follow-up period.
Results:
We analyzed 534 patients presenting with ACS who underwent coronary angiography. Of them, 56 (10.5%) presented without any SMuRF. After propensity score matching, the median SYNTAX score was 13.8 (IQR 0-22.1) in 56 SMuRF-less patients and 14 (IQR 5-25) in 166 patients with ≥1 SMuRFs. SMuRF-less status was associated with increased odds of zero SYNTAX score [zero-part model: odds ratio = 2.11, 95% confidence interval (CI): 1.03-4.33], but not with decreased SYNTAX score among patients with non-zero SYNTAX score (count-part model: incidence rate ratio = 0.99, 95% CI: 0.79-1.24); the overall distribution of the SYNTAX score was similar between the two groups (p = 0.26). The 30-day risk for all-cause mortality was higher for SMuRF-less patients compared to patients with ≥1 SMuRFs [hazard ratio (HR) = 3.58, 95% CI: 1.30-9.88]; however, the all-cause mortality risk was not different between the two groups over a median 1.7-year follow-up (HR = 1.72, 95% CI: 0.83-3.57).
Conclusion:
Among patients with ACS, the absence of SMuRFs is associated with increased odds for non-obstructive CAD and with increased short-term mortality rates.
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