Infarct severity and outcomes in ST-elevation myocardial infarction patients without standard modifiable risk factors - A multicenter cardiac magnetic resonance study

Martin Reindl, Thomas Stiermaier, Ivan Lechner, Christina Tiller, Magdalena Holzknecht, Priscilla Fink, Agnes Mayr, Gert Klug, Hans-Josef Feistritzer, Ronak Delewi, Alexander Hirsch, Jaclyn Carberry, David Carrick, Axel Bauer, Bernhard Metzler, Robin Nijveldt, Holger Thiele, Colin Berry, Ingo Eitel, Sebastian J Reinstadler*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)


BACKGROUND: Standard modifiable cardiovascular risk factors (SMuRFs) are well-established players in the pathogenesis of ST-elevation myocardial infarction (STEMI). However, in a significant proportion of STEMI patients, no SMuRFs can be identified, and the outcomes of this subgroup are not well described.

OBJECTIVES: To assess the infarct characteristics at myocardial-tissue level and subsequent clinical outcomes in SMuRF-less STEMIs.

METHODS: This multicenter, individual patient-data analysis included 2012 STEMI patients enrolled in four cardiac magnetic resonance (CMR) imaging studies conducted in Austria, Germany, Scotland, and the Netherlands. Unstable patients at time of CMR (e.g. cardiogenic shock/after cardiac arrest) were excluded. SMuRF-less was defined as absence of hypertension, smoking, hypercholesterolemia, and diabetes mellitus. All patients underwent CMR 3(interquartile range [IQR]:2-4) days after infarction to assess left ventricular (LV) volumes and ejection fraction, infarct size and microvascular obstruction (MVO). Clinical endpoints were defined as major adverse cardiovascular events (MACE), including all-cause mortality, re-infarction and heart failure.

RESULTS: No SMuRF was identified in 185 patients (9%). These SMuRF-less patients were older, more often male, had lower TIMI risk score and pre-interventional TIMI flow, and less frequently multivessel-disease. SMuRF-less patients did not show significant differences in CMR markers compared to patients with SMuRFs (all p > 0.10). During a median follow-up of 12 (IQR:12-27) months, 199 patients (10%) experienced a MACE. No significant difference in MACE rates was observed between SMuRF-less patients and patients with SMuRFs (8vs.10%, p = 0.39).

CONCLUSIONS: In this large individual patient-data pooled analysis of low-risk STEMI patients, infarct characteristics and clinical outcomes were not different according to SMuRF status.

Original languageEnglish
Pages (from-to)78-83
Number of pages6
JournalEuropean Journal of Internal Medicine
Early online date25 Aug 2023
Publication statusPublished - Jan 2024

Bibliographical note

Funding Information:
The studies included in the present analysis were supported by grants from the ‘Austrian Society of Cardiology’, the ‘Austrian Science Fund’ (FWF grant KLI 772-B), ‘Lilly’ Germany, the University of Leipzig- Heart Centre, the British Heart Foundation, and the Dutch Heart Foundation.

Publisher Copyright:
© 2023 European Federation of Internal Medicine


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