ArticleFrontiers in cardiovascular medicine2022
Prognostic Outcomes in Acute Myocardial Infarction Patients Without Standard Modifiable Risk Factors: A Multiethnic Study of 8,680 Asian Patients.
Article in Frontiers in cardiovascular medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 2 of them syntheses that pooled it.
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Who cites it
32 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Glucagon-like peptide-1 receptor agonist in myocardial infarction and atherosclerotic cardiovascular disease risk reduction: a comprehensive meta-analysis of number needed to treat, efficacy and safety.Cardiovascular diabetology · 2025Pooled it
- Sex differences in survival following acute coronary syndrome with and without standard modifiable risk factors.Clinical research in cardiology : official journal of the German Cardiac Society · 2025Pooled it
- Body composition phenotypes are key predictors of cardiovascular-kidney-metabolic multimorbidity and long-term mortality: insights from a population-based cohort study.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Article
- Cardiovascular Disease Mortality Burden in Singapore From 1990 to 2050: A Forecasting Analysis of GBD 2023 Study.JACC. Asia · 2026Article
- The Standard Modifiable Cardiovascular Risk Factor Paradox Revisited: Does the Count Matter?JACC. Asia · 2026Article
- Article
- Predictive utility of the baseline Tp-e interval for early arrhythmic events in acute myocardial infarction: A cohort study.The Journal of international medical research · 2026Article
- Systematic review of cardiovascular care delivery across health systems in the Asia-Pacific: a regional roadmap for strengthening cardiovascular care.The Lancet regional health. Western Pacific · 2026Article
- Myocardial Infarction Without Standard Modifiable Risk Factors From 2025-2040: Forecast Analysis of Multinational, Population-Based Study.JACC. Asia · 2026Article
- Long-term prognosis of coexistent metabolic dysfunction-associated steatotic liver disease and chronic kidney disease following acute myocardial infarction.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Article
- A Cross-Sectional Analytical Study: Prevalence and Clinical Profile of Metabolic Syndrome Among Middle Eastern, Mainly Jordanians, Cohort Presented with Atherosclerotic Cardiovascular Disease.Vascular health and risk management · 2026Observational
- Redefining atherosclerotic cardiovascular disease patients with no standard modifiable risk factors "SMuRF-less": six rather than four risk factors. Analysis from the Jordan SMuRF-less Study.Frontiers in cardiovascular medicine · 2026Article
- Natural history and outcomes of medically treated coronary artery disease: insights from reconstructed individual patient data of 29 randomized trials.Clinical research in cardiology : official journal of the German Cardiac Society · 2025Article
- Non-invasive scoring systems of liver fibrosis predict prognosis in the cohort with myocardial infarction.Scientific reports · 2025Article
- Poor Mental Health Status as a Risk Factor and Prognosticator in SMuRF-Less Acute Myocardial Infarction.Journal of clinical medicine · 2025Article
- In-Hospital Outcomes in Patients With Acute Myocardial Infarction and No Standard Modifiable Cardiovascular Risk Factors Across Varying Body Mass Index: Findings From the CCC-ACS Project.Journal of the American Heart Association · 2025Observational
- A sex-disaggregated analysis of the prognostic value of lean type 2 diabetes mellitus in the adult population with acute myocardial infarction.Cardiovascular diabetology · 2025Article
- Prognostic value of the atherogenic index of plasma in patients with acute coronary syndrome without standard modifiable risk factors: a machine learning-based cohort study.Frontiers in cardiovascular medicine · 2025Article
- Absence of Standard Modifiable Risk Factors in Middle Eastern Patients with Atherosclerotic Cardiovascular Disease. The Jordan Absence of Standard Modifiable Risk Factors (SMuRF-Less) Study.Vascular health and risk management · 2025Article
- Article
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Authors and funding
17 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: An increasing proportion of patients with acute myocardial infarction (AMI) are presenting without standard modifiable risk factors (SMuRFs) of hypertension, hypercholesterolemia, diabetes, and smoking, but with an unexpectedly increased mortality. This study examined the SMuRF-less patients presenting with AMI in a multiethnic Asian population. Methods: We recruited patients presenting with AMI from 2011 to 2021 and compared the prevalence, clinical characteristics, and outcomes of SMuRF-less and SMuRF patients. Multivariable analysis was used to compare the outcomes of 30-day cardiovascular mortality, all-cause mortality, readmission, cardiogenic shock, stroke, and heart failure. Kaplan-Meier curves were constructed for 30-day cardiovascular mortality, with stratification by ethnicity, gender and AMI type, and 10-year all-cause mortality. Results: Standard modifiable risk factor-less patients, who made up 8.6% of 8,680 patients, were significantly younger with fewer comorbidities that include stroke and chronic kidney disease, but higher rates of ventricular arrhythmias and inotropic or invasive ventilation requirement. Multivariable analysis showed higher rates of cardiovascular mortality (HR 1.48, 95% CI: 1.09-1.86, Conclusion: There is a significant proportion of patients with AMI without standard risk factors in Asia, who have worse short-term mortality. This calls for greater focus on the management of this unexpectedly high-risk subgroup of patients.
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