Residual cardiovascular risk and secondary cardiac events after acute myocardial infarction: prognostic insights and lipid challenges

Abstract Introduction Achievement of therapeutic goals after acute myocardial infarction reduces the risk of cardiovascular events, but doesn't entirely eliminate this risk (1), leading to the concept of residual cardiovascular risk defined as the ongoing risk of cardiovascular (CV) events despite achievement of therapeutic goals(2) (3). Objectives To assess residual cardiovascular risk using SMART and SMART REACH scores, that predict the 10-year and lifetime risk of CV events, and to evaluate achievement of therapeutic goals and occurrence of major adverse cardiovascular events (MACE) in high residual risk patients. Material and methods A cross-sectional study was conducted from May 2023 to June 2024, enrolling 174 patients with history of acute coronary syndrome (ACS) followed up in cardiology department. The SMART score and SMART REACH model were used to estimate residual CV risk, and a score ≥30% indicated high residual risk. Results Of the 174 patients enrolled (mean age 63.7 ±9.8 years, 58.6% male): 76.4% and 51.7%, respectively, had high residual risk using the SMART REACH and SMART models; among them 78.6% were prescribed high-intensity statins, 6% received Ezetimibe. However, only 48.1% achieved a 50% reduction in LDL-c, and only 25.6% and 18.8% reached LDL-c goals 0.7 g/L and 0.55 g/L. High triglyceride levels and non-HDL-c levels were prevalent in 34.6% and 72.9% of patients. Myocardial re-infarction, stroke, and death occurred in 44%, 6.3% and 3.4% respectively in high-risk patients; this was significantly associated with additional risk factors: high triglyceride, atrial fibrillation, anemia (p0.05). In contrast, myocardial infarction was observed in only 35% of high-risk diabetes patients taking SGLT2 inhibitors, compared to 53.2% of those not taking SGLT2 inhibitors (p=0.002). Conclusion This study highlights the importance of identifying high-risk patients after acute coronary syndrome, and implementing aggressive strategies to achieve therapeutic goals that remain suboptimal in this population.Baseline characteristics re myocardial infarction