Acute coronary syndrome without documented standard modifiable risk factors and the stress hyperglycaemia ratio in an Indonesian percutaneous coronary intervention registry
References
- Figtree GA, Vernon ST, Hadziosmanovic N, Sundström J, Alfredsson J, Arnott C, et al. Mortality in STEMI patients without standard modifiable risk factors: a sex-disaggregated analysis of SWEDEHEART registry data. Lancet. 2021;397(10279):1085–1094. doi:10.1016/S0140-6736(21)00272-5.
- Vernon ST, Coffey S, D'Souza M, Chow CK, Kilian J, Hyun K, et al. ST-segment-elevation myocardial infarction (STEMI) patients without standard modifiable cardiovascular risk factors — how common are they, and what are their outcomes? J Am Heart Assoc. 2019;8(21):e013296. doi:10.1161/JAHA.119.013296.
- Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):937–952. doi:10.1016/S0140-6736(04)17018-9.
- Kong G, Chew NWS, Ng CH, Chin YH, Lim OZH, Ambhore A, et al. Prognostic outcomes in acute myocardial infarction patients without standard modifiable risk factors: a multiethnic study of 8,680 Asian patients. Front Cardiovasc Med. 2022;9:869168. doi:10.3389/fcvm.2022.869168.
- Kong G, Chew NWS, Ng CH, Chin YH, Zeng R, Foo R, et al. Long-term outcomes in acute coronary syndrome patients without standard modifiable risk factors: a multi-ethnic retrospective cohort study of 5400 Asian patients. J Thromb Thrombolysis. 2022;54(4):569–578. doi:10.1007/s11239-022-02704-7.
- Sheikhy A, Fallahzadeh A, Jameie M, Aghajani H, Hosseini K. In-hospital and 1-year outcomes of patients without modifiable risk factors presenting with acute coronary syndrome undergoing PCI: a sex-stratified analysis. Front Cardiovasc Med. 2023;10:1235667. doi:10.3389/fcvm.2023.1235667.
- Kong G, Chin YH, Chong B, Goh RSJ, Lim OZH, Ng CH, et al. Higher mortality in acute coronary syndrome patients without standard modifiable risk factors: results from a global meta-analysis of 1,285,722 patients. Int J Cardiol. 2023;371:432–440. doi:10.1016/j.ijcard.2022.09.062.
- Ball J, Dinh DT, Brennan A, Ajani A, Clark DJ, Freeman M, et al. Prevalence and outcomes of patients with SMuRF-less acute coronary syndrome undergoing percutaneous coronary intervention. Open Heart. 2024;11(1):e002733. doi:10.1136/openhrt-2024-002733.
- Figtree GA, Vernon ST, Harmer JA, Gray MP, Arnott C, Bachour E, et al. Clinical pathway for coronary atherosclerosis in patients without conventional modifiable risk factors: JACC state-of-the-art review. J Am Coll Cardiol. 2023;82(13):1343–1359. doi:10.1016/j.jacc.2023.06.045.
- Jiang Z, Liu H, Qiu M, Li J, Zhao W, Zhang D, et al. Long-term outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention without standard modifiable cardiovascular risk factors: findings from the OPT-CAD cohort. BMC Med. 2025;23:112. doi:10.1186/s12916-025-03933-2.
- Capes SE, Hunt D, Malmberg K, Gerstein HC. Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet. 2000;355(9206):773–778. doi:10.1016/S0140-6736(99)08415-9.
- Roberts GW, Quinn SJ, Valentine N, Alhawassi T, O'Dea H, Stranks SN, et al. Relative hyperglycemia, a marker of critical illness: introducing the stress hyperglycemia ratio. J Clin Endocrinol Metab. 2015;100(12):4490–4497. doi:10.1210/jc.2015-2660.
- Nathan DM, Kuenen J, Borg R, Zheng H, Schoenfeld D, Heine RJ, et al. Translating the A1C assay into estimated average glucose values. Diabetes Care. 2008;31(8):1473–1478. doi:10.2337/dc08-0545.
- Xu W, Song Q, Wang X, Zhao Z, Meng X, Xia C, et al. Association of stress hyperglycemia ratio and in-hospital mortality in patients with coronary artery disease: insights from a large cohort study. Cardiovasc Diabetol. 2022;21(1):217. doi:10.1186/s12933-022-01645-y.
- Zeng G, Song Y, Zhang Z, Xu J, Liu Z, Tang X, et al. Stress hyperglycemia ratio and long-term prognosis in patients with acute coronary syndrome: a multicenter, nationwide study. J Diabetes. 2023;15(7):557–568. doi:10.1111/1753-0407.13400.
- Esdaile H, Khan S, Mayet J, Oliver N, Reddy M, Shah ASV. The association between the stress hyperglycaemia ratio and mortality in cardiovascular disease: a meta-analysis and systematic review. Cardiovasc Diabetol. 2024;23(1):412. doi:10.1186/s12933-024-02454-1.
- Kahn MG, Callahan TJ, Barnard J, Bauck AE, Brown J, Davidson BN, et al. A harmonized data quality assessment terminology and framework for the secondary use of electronic health record data. EGEMS (Wash DC). 2016;4(1):1244.
- Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023;44(38):3720–3826. doi:10.1093/eurheartj/ehad191.
- von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453–1457. doi:10.1016/S0140-6736(07)61602-X.
- Inker LA, Eneanya ND, Coresh J, Tighiouart H, Wang D, Sang Y, et al. New creatinine- and cystatin C-based equations to estimate GFR without race. N Engl J Med. 2021;385(19):1737–1749. doi:10.1056/NEJMoa2102953.
- Firth D. Bias reduction of maximum likelihood estimates. Biometrika. 1993;80(1):27–38. doi:10.1093/biomet/80.1.27.
- Baskoro SS, Rahma OA, Arthalia VDR, Maulana MZH, Waranugraha Y, Rohman MS. Predictor for premature coronary artery disease (PCAD) in Asian populations: a meta-analysis. Heart Sci J. 2026;7(3):23–31. doi:10.21776/ub.hsj.2026.007.03.5.
- Anderson JL, Knight S, May HT, Le VT, Almajed J, Bair TL, et al. Cardiovascular outcomes of ST-elevation myocardial infarction (STEMI) patients without standard modifiable risk factors (SMuRF-less): the Intermountain Healthcare experience. J Clin Med. 2023;12(1):75. doi:10.3390/jcm12010075.
Language: English
Published on: Nov 6, 2026
Published by: Romanian Society of Cardiology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
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© 2026 Sahlan Abadi, Mohammad Saifur Rohman, Wella Karolina, published by Romanian Society of Cardiology
This work is licensed under the Creative Commons Attribution 4.0 License.