Acute myocardial infarction in patients without standard modifiable risk factors -A state-of-the-art review.

Acute myocardial infarction (AMI) in patients without standard modifiable risk factors (SMuRFs) is an increasingly recognized clinical entity. Traditionally, AMI has been closely associated with SMuRFs: hypertension, diabetes, dyslipidemia, and smoking. However, a subset of patients experience AMI without any of these established risk factors, posing diagnostic and therapeutic challenges. The true prevalence of AMI in SMuRF-less patients remains unclear, and the pathogenesis of coronary artery disease in these individuals is poorly understood. Current evidence suggests that unique mechanisms, including genetic predispositions and epigenetic modifications, inflammation, mental health and other non-traditional risk factors may contribute, though these remain to be clearly defined. Furthermore, the outcomes of SMuRF-less AMI present heterogeneity. In this review, we aim to examine the available literature on the underlying pathogenesis, potential causes of AMI in SMuRF-less patients, and their short- and long-term clinical outcomes compared to AMI patients with traditional risk factors. This knowledge could contribute to developing tailored treatment strategies and improving outcomes for this patient group.