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Pattern of atherosclerotic plaque and type of MI in the patients of cardiovascular disease with and without standard modifiable cardiovascular risk factors (SMuRF)

2024; Royal College of Physicians; Volume: 24; Linguagem: Inglês

10.1016/j.clinme.2024.100188

1473-4893

Anfal Hamza, Muhammad Khalid Razaq, Ghulam Mustafa, Umair J. Chaudhary, Ali Ayan, Bismillah Sehar,

Lipoproteins and Cardiovascular Health

Standard Modifiable Cardiovascular Risk Factors (SMuRF) like smoking and hypertension, Diabetes Mellitus, and dyslipidaemias, studies reveal a concerning trend: an increasing incidence of ST-elevation myocardial infarction (STEMI) in individuals devoid of risk factors, termed SMuRFless patients. To determine the severity of Coronary Artery Disease among patients with and without Standard Modifiable Cardiovascular Risk Factors. This retrospective study, was conducted at the Cardiology ward of Sheikh Zayed Medical College, Rahim Yar Khan, from January to December 2023. The data of STEMI patients who underwent Primary PCI was retrieved from records of the Cardiology ward. STEMI patients were classified as patients with Standard Modifiable Cardiovascular Risk Factors as SMuRFs and without Standard Modifiable Cardiovascular Risk Factors as SMuRFless. Detailed patient data, including prognostic features and angiographic findings, were collected using a predefined form. Statistical analysis, executed via SPSS version-23, involved descriptive and inferential methods, controlling for potential effect modifiers like age, gender, and risk factors through stratification and Chi-Square tests. The sample size was 486. Most patients were within the age range of 46 to 60 years 259 (53.3%), with males comprising 367 (75.5%). Hypertension emerged as the most prevalent risk factor 241 (66.4%)1. 123 (25.3%) patients presented without Standard Modifiable Cardiovascular Risk Factors (SMuRFless). Several studies illustrate this phenomenon.2,3,4 STEMI without SMuRF was more common in younger patients with a statistical significance of p-value (0.005) also illustrated by Kelly et al.5 Patients with a Family History of Coronary Artery Disease and without SMuRF exhibited a predominant Multi Vessel Coronary Artery Disease of 15% vs 4% in patients with SMuRF (p = 0.05). Notably, there was a weak correlation (r = 0.10) between CAD and multiple risk factors, which slightly increased (r = 0.12) in cases with a positive family history. The study highlights the complexity of ST-elevation myocardial Infarction (STEMI) cases, emphasising the prevalence of Single, Double, or triple-vessel coronary Artery Disease and exploring associations with risk factors and family history. Gurm Z, Seth M, Daher E, Pielsticker E, Qureshi MI, Zainea M, et al. Prevalence of coronary risk factors in contemporary practice among patients undergoing their first percutaneous coronary intervention: Implications for primary prevention. Salinas P, editor. PLOS ONE. 2021 Jun 9;16(6):e0250801. Shamaki GR, Safiriyu I, Kesiena O, Mbachi C, Anyanwu M, Zahid S, et al. Prevalence and outcomes in STEMI patients without standard modifiable cardiovascular risk factors: A National Inpatient Sample Analysis. Current Problems in Cardiology. 2022 Aug;101343. Anderson JL, Knight S, May HT, Le VT, Almajed J, Bair TL, et al. Cardiovascular Outcomes of ST-Elevation Myocardial Infarction (STEMI) Patients without Standard Modifiable Risk Factors (SMuRF-Less): The Intermountain Healthcare Experience. Journal of Clinical Medicine. 2022 Dec 22;12(1):75. Vernon ST, Coffey S, D'Souza M, Chow CK, Kilian J, Hyun K, et al. ST‐Segment–Elevation Myocardial Infarction (STEMI) Patients Without Standard Modifiable Cardiovascular Risk Factors—How Common Are They, and What Are Their Outcomes? Journal of the American Heart Association. 2019 Nov 5;8(21). Kelly C, Lan NSR, Phan J, Hng C, Matthews A, Rankin JM, et al. Characteristics and Outcomes of Young Patients With ST-Elevation Myocardial Infarction Without Standard Modifiable Risk Factors. The American Journal of Cardiology [Internet]. 2023 Sep 1 [cited 2024 Feb 20];202:81–9. Available from: https://pubmed.ncbi.nlm.nih.gov/37423175/