Angiographic severity in acute coronary syndrome patients with and without standard modifiable risk factors

Abstract

BackgroundRoutine coronary artery disease (CAD) secondary prevention strategies target standard modifiable cardiovascular risk factors (SMuRFs), which include: diabetes mellitus, dyslipidemia, hypertension, and smoking. However, a significant proportion of patients with acute coronary syndrome (ACS) present without any SMuRFs. The angiographic severity of disease in this population has not yet been investigated.MethodsAfter propensity score matching of patients without SMuRFs and patients with ≥1 SMuRFs (ratio 1:3), we used zero-inflated negative binomial regression modeling to investigate the relationship of SMuRF-less status with the angiographic severity of CAD, as measured by the SYNTAX score. Survival analysis was performed to investigate differences in all-cause mortality at 30 days and at the end of follow-up period.ResultsWe analyzed 534 patients presenting with ACS who underwent coronary angiography. Of them, 56 (10.5%) presented without any SMuRF. After propensity score matching, the median SYNTAX score was 13.8 (IQR 0–22.1) in 56 SMuRF-less patients and 14 (IQR 5–25) in 166 patients with ≥1 SMuRFs. SMuRF-less status was associated with increased odds of zero SYNTAX score [zero-part model: odds ratio = 2.11, 95% confidence interval (CI): 1.03–4.33], but not with decreased SYNTAX score among patients with non-zero SYNTAX score (count-part model: incidence rate ratio = 0.99, 95% CI: 0.79–1.24); the overall distribution of the SYNTAX score was similar between the two groups (p = 0.26). The 30-day risk for all-cause mortality was higher for SMuRF-less patients compared to patients with ≥1 SMuRFs [hazard ratio (HR) = 3.58, 95% CI: 1.30–9.88]; however, the all-cause mortality risk was not different between the two groups over a median 1.7-year follow-up (HR = 1.72, 95% CI: 0.83–3.57).ConclusionAmong patients with ACS, the absence of SMuRFs is associated with increased odds for non-obstructive CAD and with increased short-term mortality rates.

Effect of Cardiovascular Risk Factors on 30-Day All-Cause Mortality in Cardiogenic Shock

“…Considering baseline characteristics, the results of the low CVR group of our study are comparable with current literature, in that SMuRF-less patients are less likely to present with a prior history of heart failure and stroke [11][12][13]20]. However, a major difference of our study is, that contrary to literature describing impaired short-term prognosis of patients without SMuRFs [9][10][11][12][13][14]20], 30-day all-cause mortality of patients with low and high CVR was comparable in our study.…”

“…While a few studies focusing on the prognostic outcome of SMuRFs in patients with acute coronary syndrome (ACS) are available, to the best of the authors knowledge, no studies investigating the influence of SMuRFs in patients with CS were published yet [9][10][11][12][13][14]. Therefore, this study aims to analyse the prognostic value of SMuRFs by comparing CS patients with high (i.e., 2-4 CVR factors) vs. low CVR (i.e., 0-1 CVR factors) with regard to 30-day all-cause mortality.…”

Epicardial fat volume evaluated with multidetector computed tomography and other risk factors for prevalence of three-vessel coronary lesions

“…Abnormal increase of epicardial fat was defined as the epicardial fat volume greater than 90.0 ml. The body mass index (BMI) for Chinese people was calculated as BMI = body weight (kg)/height (m) [ 2 ].

Fig.

…”