SPC365

Acute coronary syndromes without the usual suspects: prevalence and clinical outcomes of patients without standard modifiable risk factors (SMuRF-less)

Session: SESSÃO DE POSTERS 37 - DOENÇAS CARDIOVASCULARES - TERAPÊUTICA ANTITROMBÓTICA
Speaker: Helena Sofia Santos Moreira

Congress: CPC 2025
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type: Cartazes
FP Number: ---
Authors: Helena Sofia Santos Moreira; Pedro Mangas Palma; Miguel Rocha; Cátia Oliveira; Ana Isabel Pinho; Luís Santos; Joana Gonçalves; Bernardo Cruz; Emanuel Oliveira; Rui André Rodrigues; Ana Lebreiro

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos Display&quot;,sans-serif"><strong>Background:</strong> Clinical outcomes of acute coronary syndromes (ACS) in patients (pts) without standard modifiable risk factors (SMuRF) are reportedly comparable, yet this population remains underrepresented in major clinical trials, raising the need for further research.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos Display&quot;,sans-serif"><strong>Purpose:</strong>&nbsp;To describe and compare the prevalence and clinical outcomes of SMuRF and SMuRF-less pts hospitalized with ACS. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos Display&quot;,sans-serif"><strong>Methods:</strong> We conducted a retrospective analysis on pts admitted due to ACS in our centre from 2009 to 2023. Pts were categorized as SMuRF (&ge; 1 risk factor: arterial hypertension, dyslipidemia, overweight, smoking and diabetes mellitus) or SMuRF-less (no standard risk factors). The primary individual endpoints included in-hospital all-cause mortality and ACS complications. Comprehensive data was collected via medical records review.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos Display&quot;,sans-serif"><strong>Results:</strong> A total of 3539 pts were included, with 96.5% (n=3415) classified as SMuRF and 3.5% (n=124) as SMuRF-less. SMuRF-less pts were mostly female (52.4% in SMuRF-less vs. 32.3% in SMuRF; p&lt;0.001; OR 2.3, 95% CI: 1.6-3.3). Other baseline characteristics, including mean age (64 &plusmn; 13 years; p=0.074), family history of premature cardiovascular (CV) disease (7.3%; p=0.97), and prior coronary revascularization (12%; p=0.89), were similar. Arterial hypertension and dyslipidemia were the most prevalent risk factors in SMuRF pts (68%). </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos Display&quot;,sans-serif">Non-ST segment elevation myocardial infarction (NSTEMI) was the most common diagnosis in both groups (45.1% in SMuRF vs. 45% in SMuRF-less; p=0.26). SMuRF-less pts presented more frequently with cardiac arrest (4.8% in SMuRF-less vs. 1.96% in SMuRF; p=0.041; OR 2.4, 95% CI: 1.08-5.98) while SMuRF pts tended to have more multivessel disease (56.8%; p=0.001; OR 1.8, 95% CI: 1.26-2.69). Most pts had percutaneous coronary intervention (56.4% in SMuRF vs. 54.8% in SMuRF-less; p=0.59). </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos Display&quot;,sans-serif">Approximately one-fourth of the pts had ACS complications (16.7% in SMuRF vs. 20.2% in SMuRF-less; p=0.31) - Figure 1. Rhythm disturbances were the most frequent, with new-onset of atrial fibrillation (AF) being more common in SMuRF-less pts (32% in SMuRF-less vs. 17.4% SMuRF; p=0.032; OR 2.3, 95% CI 1.10-4.86). Cardiogenic shock and mechanical complications accounted for 2% of the SMuRF complications, with no cases in SMuRF-less pts (p=0.68 and p=0.63, respectively). In-hospital mortality was low (0.4% in SMuRF vs. no deaths in SMuRF-less; p=0.63). Both groups had median discharge at 6 days (IQR 5; p=0.89).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos Display&quot;,sans-serif"><strong>Conclusion:&nbsp;</strong>SMuRF-less pts represented a small subset of the ACS population in our study, likely reflecting the high prevalence of CV risk factors. Within the SMuRF-less pts there was a notable predominance of female pts, as well as higher rates of cardiac arrest at presentation and new-onset of AF during hospitalization. These findings highlight the need for targeted research and tailored strategies to optimize care for this underrepresented population.</span></span></span></span></p>