Acute myocardial infarction in patients without standard modifiable risk factors - preliminary data on clinical and laboratory biomarkers from the beyond-smurfs study

Abstract

Abstract Background Acute myocardial infarction (AMI) remains the leading cause of mortality worldwide. The majority of patients who suffer an AMI have a history of at least one of the standard modifiable risk factors (SMuRFs): smoking, hypertension, dyslipidemia, and diabetes mellitus. However, emerging scientific evidence recognizes a clinically significant and increasing proportion of patients presenting with AMI without any SMuRF (SMuRF-less patients). This study aims to define specific risk factors or biomarkers associated with the development of AMI in this subpopulation. Methods This is an analysis of the prospective ‘‘Beyond-SMuRFs" study reporting preliminary data of the first 350 consecutive patients with AMI fulfilling inclusion criteria. More than 300 clinical, laboratory, echocardiographic and angiographic parameters-variables were compared between patients with and without SMuRFs. Multivariable logistic regression analysis was implemented to investigate independent prognostic factors associated with the occurrence of SΜuRF-less AMIs. Only univariably-significant (P<0.05) and clinically-relevant variables were inserted in in the models. Restricted spline curve models were utilized to demonstrate the association of significant continuous predictors with the risk of SMuRF-less AMI occurrence. Results Out of the 350 patients (mean age 60.8±12.0 years, 74.6% males) suffering AMI, 76 patients (21.7%) had no history of SMuRFS at baseline. Increased soluble urokinase plasminogen activator receptor (suPAR) levels, history of rheumatic or autoimmune disease, values of self-reported mental health status component of SF-36 questionnaire ≤50 prior to AMI and decreased age were univariably associated with increased risk for SMuRF-less AMI. In the multivariable regression model, increased suPAR levels (aOR= 1.001; 95% CI= 1.000-1.003; p=0.02 β=0.001), history of rheumatic or autoimmune disease (aOR= 2.634; 95% CI= 2.309-4.440; p<0.001; β=1.848) and impaired mental health status retained their statistical significance (aOR= 0.413, 95% CI= 0.229-0.746; p=0.003; β=0.884). Conclusions In this prospective cohort of 350 consecutive patients with AMI, more than a fifth of them were SMuRF-less. History of prior rheumatic or autoimmune disease, increased suPAR levels and decline in self-reported mental health status metrics prior to AMI were found to be independent predictors of SMuRF-less AMI.Multivariable logistic regression modelRestricted spline curve models