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Infarct severity and outcomes in ST-elevation myocardial infarction patients without standard modifiable risk factors
Martin Reindl1, Thomas Stiermaier2, Ivan Lechner1
1University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, 6020, Innsbruck, Austria.
Insights
In ST-elevation myocardial infarction (STEMI) patients without standard modifiable cardiovascular risk factors (SMuRFs), cardiac magnetic resonance imaging shows similar infarct characteristics. Clinical outcomes, including major adverse cardiovascular events, were also comparable between SMuRF-less and SMuRF STEMI patients.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Clinical Research
Background:
- Standard modifiable cardiovascular risk factors (SMuRFs) are key in ST-elevation myocardial infarction (STEMI) pathogenesis.
- A notable subset of STEMI patients lack identifiable SMuRFs, with poorly understood outcomes.
- Investigating these SMuRF-less STEMI cases is crucial for comprehensive understanding.
Purpose of the Study:
- To evaluate myocardial infarct characteristics using cardiac magnetic resonance (CMR) in STEMI patients without SMuRFs.
- To compare clinical outcomes, specifically major adverse cardiovascular events (MACE), in SMuRF-less STEMI patients versus those with SMuRFs.
Main Methods:
- A pooled analysis of 2012 STEMI patients from four multicenter CMR studies.
- SMuRF-less defined as absence of hypertension, smoking, hypercholesterolemia, and diabetes mellitus.
- CMR assessed left ventricular function, infarct size, and microvascular obstruction; MACE included mortality, re-infarction, and heart failure.
Main Results:
- 185 patients (9%) were identified as SMuRF-less; they were older, more often male, and had lower baseline risk scores.
- No significant differences in CMR-derived infarct characteristics (e.g., infarct size, MVO) were found between SMuRF-less and SMuRF groups.
- Median follow-up of 12 months revealed comparable MACE rates (8% vs. 10%, p=0.39) between the two groups.
Conclusions:
- In low-risk STEMI patients, the absence of SMuRFs does not correlate with distinct infarct characteristics on CMR.
- Clinical outcomes, measured by MACE, are similar in STEMI patients with and without SMuRFs.
- This suggests that SMuRF status may not be a primary determinant of infarct characteristics or short-term prognosis in all STEMI patients.
Background:
Standard modifiable cardiovascular risk factors (SMuRFs) are well-established players in the pathogenesis of ST-elevation myocardial infarction (STEMI). However, in a significant proportion of STEMI patients, no SMuRFs can be identified, and the outcomes of this subgroup are not well described.
Objectives:
To assess the infarct characteristics at myocardial-tissue level and subsequent clinical outcomes in SMuRF-less STEMIs.
Methods:
This multicenter, individual patient-data analysis included 2012 STEMI patients enrolled in four cardiac magnetic resonance (CMR) imaging studies conducted in Austria, Germany, Scotland, and the Netherlands. Unstable patients at time of CMR (e.g. cardiogenic shock/after cardiac arrest) were excluded. SMuRF-less was defined as absence of hypertension, smoking, hypercholesterolemia, and diabetes mellitus. All patients underwent CMR 3(interquartile range [IQR]:2-4) days after infarction to assess left ventricular (LV) volumes and ejection fraction, infarct size and microvascular obstruction (MVO). Clinical endpoints were defined as major adverse cardiovascular events (MACE), including all-cause mortality, re-infarction and heart failure.
Results:
No SMuRF was identified in 185 patients (9%). These SMuRF-less patients were older, more often male, had lower TIMI risk score and pre-interventional TIMI flow, and less frequently multivessel-disease. SMuRF-less patients did not show significant differences in CMR markers compared to patients with SMuRFs (all p > 0.10). During a median follow-up of 12 (IQR:12-27) months, 199 patients (10%) experienced a MACE. No significant difference in MACE rates was observed between SMuRF-less patients and patients with SMuRFs (8vs.10%, p = 0.39).
Conclusions:
In this large individual patient-data pooled analysis of low-risk STEMI patients, infarct characteristics and clinical outcomes were not different according to SMuRF status.
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