In-Hospital and 1-Year Outcomes of Patients Without Modifiable Risk Factors Presenting With Acute Coronary Syndrome Undergoing Pci: A Sex-Stratified Analysis Publisher



Sheikhy A^{1, 2} ; Fallahzadeh A^{1, 2} ; Jameie M^{1, 2} ; Aein A^{1, 2} ; Masoudkabir F^{1, 2} ; Maghsoudi M³ ; Tajdini M^{1, 2} ; Salarifar M^{1, 2} ; Jenab Y^{1, 2} ; Pourhosseini H^{1, 2} ; Mehrani M^{1, 2} ; Alidoosti M^{1, 2} ; Vasheghanifarahani A² ; Hosseini K^{1, 2} Show Affiliations
Source: Frontiers in Cardiovascular Medicine Published:2023

Abstract

Aim: A considerable proportion of patients admitted with acute coronary syndrome (ACS) have no standard modifiable cardiovascular risk factors (SMuRFs: hypertension, diabetes mellitus, dyslipidemia, and cigarette smoking). The outcomes of this population following percutaneous coronary intervention (PCI) are debated. Further, sex differences within this population have yet to be established. Methods: This retrospective cohort study included 7,847 patients with ACS who underwent PCI. The study outcomes were in-hospital mortality, all-cause mortality, and major adverse cardio-cerebrovascular events (MACCE). The association between the absence of SMuRFs (SMuRF-less status) and outcomes among all the patients and each sex was assessed using logistic and Cox proportional hazard regressions. Results: Approximately 11% of the study population had none of the SMuRFs. During 12.13 [11.99–12.36] months of follow-up, in-hospital mortality (adjusted-odds ratio (OR):1.51, 95%confidence interval (CI): 0.91–2.65, P:0.108), all-cause mortality [adjusted-hazard ratio (HR): 1.01, 95%CI: 0.88–1.46, P: 0.731], and MACCE (adjusted-HR: 0.93, 95%CI:0.81–1.12, P: 0.412) did not differ between patients with and without SMuRFs. Sex-stratified analyses recapitulated similar outcomes between SMuRF+ and SMuRF-less men. In contrast, SMuRF-less women had significantly higher in-hospital (adjusted-OR: 3.28, 95%CI: 1.92–6.21, P < 0.001) and all-cause mortality (adjusted-HR:1.41, 95%CI: 1.02–3.21, P: 0.008) than SMuRF+ women. Conclusions: Almost one in 10 patients with ACS who underwent PCI had no SMuRFs. The absence of SMuRFs did not confer any benefit in terms of in-hospital mortality, one-year mortality, and MACCE. Even worse, SMuRF-less women paradoxically had an excessive risk of in-hospital and one-year mortality. 2023 Sheikhy, Fallahzadeh, Jameie, Aein, Masoudkabir, Maghsoudi, Tajdini, Salarifar, Jenab, Pourhosseini, Mehrani, Alidoosti, Vasheghani-Farahani and Hosseini.