Clinical Pathway for Coronary Atherosclerosis in Patients Without Conventional Modifiable Risk Factors: JACC State-of-the-Art Review
Figtree GA., Vernon ST., Harmer JA., Gray MP., Arnott C., Bachour E., Barsha G., Brieger D., Brown A., Celermajer DS., Channon KM., Chew NWS., Chong JJH., Chow CK., Cistulli PA., Ellinor PT., Grieve SM., Guzik TJ., Hagström E., Jenkins A., Jennings G., Keech AC., Kott KA., Kritharides L., Mamas MA., Mehran R., Meikle PJ., Natarajan P., Negishi K., O'Sullivan J., Patel S., Psaltis PJ., Redfern J., Steg PG., Sullivan DR., Sundström J., Vogel B., Wilson A., Wong D., Bhatt DL., Kovacic JC., Nicholls SJ., Ademi Z., Avis SR., Chan A., Contreras O., Coorey CP., Fathieh S., Genetzakis E., Gholipour A., Giles C., Hollings M., Hyun K., Kazi S., Larance M., Marathe JA., Marquina C., Nelson A., Ng HH., Patrick E., Peter K., Tran A., Yang J., Zhu D., Zwack C.
Reducing the incidence and prevalence of standard modifiable cardiovascular risk factors (SMuRFs) is critical to tackling the global burden of coronary artery disease (CAD). However, a substantial number of individuals develop coronary atherosclerosis despite no SMuRFs. SMuRFless patients presenting with myocardial infarction have been observed to have an unexpected higher early mortality compared to their counterparts with at least 1 SMuRF. Evidence for optimal management of these patients is lacking. We assembled an international, multidisciplinary team to develop an evidence-based clinical pathway for SMuRFless CAD patients. A modified Delphi method was applied. The resulting pathway confirms underlying atherosclerosis and true SMuRFless status, ensures evidence-based secondary prevention, and considers additional tests and interventions for less typical contributors. This dedicated pathway for a previously overlooked CAD population, with an accompanying registry, aims to improve outcomes through enhanced adherence to evidence-based secondary prevention and additional diagnosis of modifiable risk factors observed.