Early and late outcomes of patients presenting with STEMI in the absence of standard modifiable risk factors: a reperfusion strategy aggregated analysis

Background: Although patients presenting with STEMI without standard modifiable cardiovascular risk factors (SMuRFs; hypertension, hypercholesterolemia, smoking, diabetes) may experience worse outcomes than those with one or more SMuRFs, the impact of reperfusion strategy on outcomes in this population has not been previously reported. Methods: Data for all patients who underwent PCI for STEMI at Liverpool Hospital, Sydney, between October 2003 and December 2021 was collected prospectively. Clinical outcomes were evaluated in patients with and without SMuRFs, stratified by reperfusion strategy: primary PCI (pPCI) versus pharmaco-invasive PCI[PI-PCI]). Results: Amongst 4149 STEMI patients, 805 (19 %) had no SMuRFs and 3344 (81 %) had ≥1 SMuRF(s). Within the SMuRF-less group, 61 % (492) underwent pPCI and 39 % (313) received PI- PCI. Amongst patients with SMuRFs, 68 % (2268) underwent pPCI and 32 % (1076) were treated with PI-PCI. Unadjusted 30- day mortality in SMuRF-less patients was 6.3 % (51) (8.3 % (41) pPCI, 3.2 % (10) PI-PCI) and for those with ≥1 SMuRF was 4.9 % (163) (5.7 % (130) pPCI, 3.1 % (33) PI-PCI). Adjusted 30-day mortality hazard ratios indicated higher mortality for patients without SMuRFs compared to those with SMuRFs (HR 1.40 [95 % CI: 1.03–1.92, p < 0.01]). Interestingly, amongst patients who underwent pPCI (HR 1.61 [95 % CI: 1.16–2.25, p < 0.01]), this difference in mortality was attenuated compared to patients who underwent PI-PCI (1.03 [95 % CI: 0.51–2.09, p = 0.93]). Conclusion: Patients presenting with STEMI in the absence of SMuRFs have higher 30- day mortality compared to those with one or more SMuRFs. Notably, this difference in mortality was not observed amongst patients treated with PI-PCI.