Acute coronary syndrome remains a leading cause of mortality worldwide, yet a subset of patients presents without traditional risk factors such as diabetes, dyslipidemia, hypertension, or smoking. Findings presented at the European Society of Cardiology 2025 Congress examined outcomes in SMuRF-less patients undergoing percutaneous coronary intervention in the SHINANO registry.
Among 1,638 patients, 124 (7.6%) had no SMuRFs, with a higher proportion in the acute coronary syndrome group (9.2% vs. 6.4%, P=0.037). SMuRF-less patients were older and less frequently prescribed secondary prevention medications at discharge. At two years, SMuRF-less acute coronary syndrome patients exhibited a 2-year major adverse cardiovascular events rate of 18.2% versus 9.5% for patients with risk factors (log-rank P=0.046), predominantly driven by an increased stroke incidence (13.9% vs. 3.6%, P<0.001).
Multivariable analysis confirmed the absence of SMuRFs as an independent predictor of adverse events in acute coronary syndrome (hazard ratio 2.20, 95% CI 1.14–4.23, P=0.018). In contrast, outcomes in chronic coronary syndrome patients were not significantly affected. These findings emphasize the need for heightened vigilance and potentially alternative therapeutic strategies for SMuRF-less acute coronary syndrome patients.
