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Long-term outcomes in acute coronary syndrome patients without standard modifiable risk factors: a multi-ethnic retrospective cohort study Of 5400 asian patients

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Abstract

A sizeable number of patients without standard modifiable cardiovascular risk factors (SMuRFs), such as hypertension, diabetes, hypercholesterolemia and smoking, suffer from acute coronary syndrome (ACS). These SMuRF-less patients have high short-term morbidity and mortality. We compared both short- and long-term outcomes of SMuRF-less and SMuRF ACS patients in a multi-ethnic Asian cohort.

This was a retrospective study of patients with first ACS from 2011 to 2017. The primary outcome was long-term all-cause mortality. Secondary outcomes were 30-day all-cause mortality, cardiac-mortality, unplanned cardiac readmission, cardiogenic shock, heart failure, and stroke. Subgroup analysis was carried out by sex and ACS type.

Of 5400 patients, 8.6% were SMuRF-less. The median follow-up time was 6.3 years (interquartile range [IQR] 4.2–8.2 years). SMuRF-less patients were younger and tended to present with ST-segment elevation myocardial infarction (STEMI). They were more likely to require inotropic support, intubation, and have cardiac arrest. At 30 days, SMuRF-less patients had higher rates of all-cause mortality, cardiac-related mortality and cardiogenic shock, but lower rates of heart failure. At 6 years, all-cause mortality was similar in both groups (18.0% versus 17.1% respectively, p = 0.631). Kaplan–Meier curves showed increased early mortality in the SMuRF-less group, but the divergence in survival curves was no longer present in the long-term. The absence of SMuRF was an independent predictor of mortality, regardless of sex or ACS type.

In a multi-ethnic cohort of patients with ACS, SMuRF-less patients were observed to have higher mortality than SMuRF patients during the early stages which was attenuated over time.

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  1. Gwyneth Kong and Nicholas W.S. Chew these authors contributed equally to the manuscript as co-first authors.

Authors and Affiliations

  1. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Gwyneth Kong, Cheng Han Ng, Yip Han Chin, Rebecca Zeng, Roger Foo, Koo Hui Chan, Adrian Fatt-Hoe Low, Chi-Hang Lee, Mark Yan-Yee Chan, Tiong-Cheng Yeo, Huay-Cheem Tan & Poay-Huan Loh

  2. Department of Cardiology, National University Heart Centre, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore

    Nicholas W. S. Chew, Roger Foo, Koo Hui Chan, Adrian Fatt-Hoe Low, Chi-Hang Lee, Mark Yan-Yee Chan, Tiong-Cheng Yeo, Huay-Cheem Tan & Poay-Huan Loh

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  1. Gwyneth Kong
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Kong, G., Chew, N.W.S., Ng, C.H. et al. Long-term outcomes in acute coronary syndrome patients without standard modifiable risk factors: a multi-ethnic retrospective cohort study Of 5400 asian patients. J Thromb Thrombolysis 54, 569–578 (2022). https://doi.org/10.1007/s11239-022-02704-7

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