Treatment Disparities and Prognosis among Myocardial Infarction Patients without Standard Modifiable Risk Factors

It is increasingly recognized that patients might suffer from acute coronary syndrome (ACS) in the absence of standard modifiable risk factors (SMuRFs). Their treatment remains largely empirical and follows the same principles for counterparts with SMuRFs. We examined whether the absence of SMuRFs affects hospital management and outcomes.

CALLINICUS-Hellas Registry is an observational prospective study evaluating the adherence to lipid-lowering therapy among ACS patients. Two groups were created according to SMuRF status. The patients were followed for 12 months after hospital discharge, and the study's endpoints were the development of new ACS, cardiac death, and non-cardiac death.

A total of 2,718 consecutive patients with ACS were included, and 68 cases (2.5%) were SMuRF-less. Low-density lipoprotein-cholesterol (LDL-cholesterol), triglycerides, and waist circumference were higher among patients with SMuRFs. SMuRF-less patients were more likely to have one vessel or nonobstructive coronary artery disease and less likely to receive reperfusion or dual antiplatelet therapy. On the contrary, non-cardiac death, cardiac death, and new ACS did not differ between groups. B-blockers and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker were equally prescribed between groups, yet patients with SMuRFs were more likely to receive ezetimibe combined with high-intensity statins at discharge. SMuRF-less patients were more likely to attain lower LDL-cholesterol levels after 12 months of follow-up and to achieve values below 55 mg/dL.

SMuRF status is associated with treatment disparities among contemporary ACS patients, and the absence of traditional risk factors does not dictate benign prognosis.