Observational studyJournal of the American Heart Association2025
In-Hospital Outcomes in Patients With Acute Myocardial Infarction and No Standard Modifiable Cardiovascular Risk Factors Across Varying Body Mass Index: Findings From the CCC-ACS Project.
Observational study in Journal of the American Heart Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Naples Prognostic Score and Clinical Outcomes After PCI for Acute Coronary Syndrome: A Systematic Review and Meta-Analysis.Clinical cardiology · 2026Pooled it
- The Standard Modifiable Cardiovascular Risk Factor Paradox Revisited: Does the Count Matter?JACC. Asia · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIndividuals who present with acute myocardial infarction in the absence of standard modifiable cardiovascular risk factors (ie, SMuRF-less) seem to have a significantly increased risk of mortality; however, it remains unclear whether the "SMuRF paradox" would be influenced by patients' baseline body mass index (BMI) status.
methodsUsing data from the CCC-ACS (Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome) project from November 2014 to July 2019, we analyzed patients with acute myocardial infarction with and without SMuRFs and categorized their BMI as underweight (<18.5 kg/m
resultsThe study included 44 538 patients with first-presentation acute myocardial infarction, of whom 4454 were SMuRF-less. The incidence of SMuRF-lessness declined from 16.2% to 6.5% as BMI increased by category, and it prevailed more frequently among women and older people regardless of their BMI status. Patients who were SMuRF-less had a significant increase in in-hospital mortality than patients with ≥1 SMuRF (adjusted odds ratio [OR], 1.750 [95% CI, 1.057-2.896],
conclusionsAmong patients with first-presentation acute myocardial infarction, compared with those with ≥1 SMuRF, patients who were SMuRF-less have a significantly higher risk of in-hospital mortality, especially in those underweight, whereas in-hospital survival was the most favorable among patients with ≥1 SMuRF and obesity. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT0230661.
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Registered trials
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