Physicians' Academy for Cardiovascular Education

Women without CV risk factors have the highest mortality risk after STEMI

Mortality in STEMI patients without standard modifiable risk factors: a sex-disaggregated analysis of SWEDEHEART registry data

Literature - Figtree GA, Vernon ST, Hadziosmanovic N et al., - Lancet. 2021 Mar 20;397(10279):1085-1094. doi: 10.1016/S0140-6736(21)00272-5.

Introduction and methods

Targeted therapies against standard modifiable cardiovascular risk factors (SMuRFs; hypertension, diabetes, hypercholesterolemia, and smoking) have led to improvements in the prevention and treatment of coronary artery diseases [1,2]. However, ST-elevation myocardial infarction (STEMI) in patients without modifiable risk factors is not uncommon [1]. Several studies have shown an increase in the proportion of SMuRF-less patients who present with STEMI [3-6]. Data on the characteristics and outcomes of SMuRF-less patients is often missing in clinical trial publications. This study examined the characteristics and outcomes in STEMI patients without SMuRFs using data from the SWEDEHEART registry.

The SWEDEHEART registry enrolls all patients with MI admitted to cardiac care units in Sweden. This study analyzed data from 62048 patients (32.9% women) who were ≥18 years, presented with suspected ACS, and had a hospital diagnosis of STEMI. Patients with a known history of CAD (PCI, CABG, or MI) were excluded. Of the 62048 patients, 9228 (14.9%) were SMuRF-less. The primary outcome was all-cause mortality at 30 days after STEMI. Secondary outcomes included MACE, CV mortality, rehospitalization for HF, stroke, coronary revascularization, major bleeding, and in-hospital cardiogenic shock. Median follow-up was 4.9 (IQR 1.8-8.5) years.

Main results


All-cause mortality at 30 days after STEMI was significantly higher in patients without SMuRFs, compared to patients with at least one SMuRF. The association of SMuRF-less status with increased mortality was particularly evident in women. The authors state that these findings counter the assumption that less traditional risk factors for atherosclerosis result in lower risk after MI, and that evidence-based pharmacotherapy should be prescribed during the immediate post-infarct period irrespective of baseline risk factors or sex.


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Find this article online at The Lancet.

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