Evidence map›Paper›PMID 41606783›Full record

ArticleEuropean heart journal. Quality of care & clinical outcomes2026

The paradox of SMURF-less outcomes and its implication for diabetes.

Edina Cenko, Olivia Manfrini, Jinsung Yoon, Maria Bergami, Zorana Vasiljevic, Guiomar Mendieta, Marija Zdravkovic, Marija Vavlukis, Sasko Kedev, Davor Miličić and 3 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in European heart journal. Quality of care & clinical outcomes, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors.

Edina CenkoDepartment of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, Bologna 40138, Italy.ORCID 0000-0001-8102-3324
Olivia ManfriniDepartment of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, Bologna 40138, Italy.ORCID 0000-0002-5652-2401
Jinsung YoonGoogle Cloud AI, Sunnyvale, CA, USA.ORCID 0000-0002-5481-5171
Maria BergamiDepartment of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, Bologna 40138, Italy.ORCID 0000-0002-1389-0597
Zorana VasiljevicMedical Faculty, University of Belgrade, Belgrade, Serbia.
Guiomar MendietaDepartment of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain and Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.ORCID 0000-0001-6652-9036
Marija ZdravkovicFaculty of Medicine, Clinical Hospital Center Bezanijska Kosa, University of Belgrade, Belgrade, Serbia.
Marija VavlukisUniversity Clinic for Cardiology  Skopje, Republic of North Macedonia.ORCID 0000-0002-4479-6691
Sasko KedevUniversity Clinic for Cardiology  Skopje, Republic of North Macedonia.
Davor MiličićDepartment for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia.
Filippo OttaniDipartimento di Cardiologia, Ospedale 'Infermi'di Rimini, Rimini, Italy.
Lina BadimonUniversity of Vic - UCC, School of Medicine and IRIS-CC Research Center, Vic; CiberCV, institute Carlos III; and Cardiovascular Research Foundation for Health and Innovation, Barcelona, Spain.
Raffaele BugiardiniDepartment of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, Bologna 40138, Italy.ORCID 0000-0002-6819-6818

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsIndividuals without standardized modifiable risk factors (SMuRF), which implicitly include those with diabetes, have been paradoxically reported to experience higher mortality following acute coronary syndromes (ACS). We aim to clarify the independent impact of diabetes on 30-day mortality after ACS and explore how grouping it with other SMuRF might obscure its true effect. METHODS AND

resultsWe analyzed 70 953 first-time ACS patients using inverse probability weighting to adjust for potential confounding. Mortality within 30 days post-ACS was the primary outcome. Diabetic patients without other SMuRF showed a significantly higher 30-day mortality compared with those without any SMuRF, with relative risks (RRs) of 1.29 for women (95% CI, 1.06-1.57) and 1.40 for men (95% CI, 1.16-1.69). When diabetes was combined with other SMuRF, its impact on mortality was diluted. Diabetic patients who were also smokers had RRs of 1.39 in women (95% CI, 0.92-2.09) and 0.89 in men (95% CI, 0.68-1.17), those with hypercholesterolaemia had RRs of 0.91 in women (95% CI, 0.66-1.25) and 0.75 in men (95% CI, 0.53-1.06) and those with hypertension showed RRs of 1.14 in women (95% CI, 0.99-1.32) and 1.12 in men (95% CI, 0.96-1.31).

conclusionDiabetes independently increases 30-day mortality risk in ACS. Aggregating it with other SMuRF masks this risk due to dilution bias, highlighting the need for individualized risk factor assessment strategies.

Indexed as

Acute Coronary SyndromeDiabetes MellitusAgedFemaleHumansMaleMiddle AgedPrognosisRisk AssessmentRisk FactorsSurvival RateAcute coronary syndromesCoronary heart diseaseMortalityOutcomesStandardized modifiable risk factors

Identifiers

PMID41606783
PMCPMC13288731

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.