Incremental Impact of Standard Modifiable Cardiovascular Risk Factors on Long-Term Outcomes After Acute Myocardial Infarction

BACKGROUND: The lack of standard modifiable cardiovascular risk factors (SMuRFs), including hypertension, diabetes, dyslipidemia, and smoking, is linked to worse in-hospital outcomes in acute myocardial infarction (AMI). Whether the number of SMuRFs is associated with long-term outcomes after AMI remains unclear. OBJECTIVES: The authors aimed to evaluate the incremental prognostic impact of the number of SMuRFs on outcomes after discharge in patients with AMI. METHODS: This multicenter, retrospective registry included 2,059 patients with AMI who underwent primary percutaneous coronary intervention. Patients were categorized according to the number of SMuRFs (0-4). The primary endpoint was major adverse cardiovascular events (MACEs), a composite of cardiovascular death, heart failure rehospitalization, recurrent AMI, and ischemic stroke. In addition, we assessed the relative prognostic impact among the 4 SMuRFs. RESULTS: Of the 2,059 patients, 96 (4.7%), 489 (23.7%), 779 (37.8%), 562 (27.3%), and 133 (6.5%) had 0, 1, 2, 3, and 4 SMuRFs, respectively. During the median follow-up period of 538 (IQR: 349-1316) days, 210 of 2,059 (10.2%) patients experienced an MACE. The overall risk of MACE did not differ across the groups, whereas the number of SMuRFs was progressively associated with an increased risk of recurrent AMI. Among the 4 SMuRFs, hypertension was independently associated with MACE in multivariable analysis (adjusted HR: 1.629; 95% CI: 1.117-2.376). CONCLUSIONS: The long-term cardiovascular risk after discharge did not differ significantly by the number of SMuRFs in patients with AMI. Among the 4 SMuRFs, hypertension was associated with an increased risk of an MACE.