Coronary disease & ACSCohort study
The paradox of SMURF-less outcomes and its implication for diabetes
- cohort analysis using inverse probability weighting
Authors' conclusion
Diabetes independently increases 30-day mortality risk in ACS. Aggregating it with other SMuRF masks this risk due to dilution bias, highlighting the need for individualized risk factor assessment strategies.
Study context
- Population
- First-time acute coronary syndromes (ACS) patients
- Participants
- 70,953 first-time ACS patients
- Exposure
- Diabetic patients without other SMuRF compared with those without any SMuRF
- Outcome
- Mortality within 30 days post-ACS
- Follow-up
- 30 days
Main finding
As reported in the abstract
Diabetic patients without other SMuRF vs Without any SMuRFRelative risk (95% CI)
women
1.29(1.06–1.57)
men
1.40(1.16–1.69)
Observational data: associations, not effects.
Further findings
| Outcome | RR (95% CI) | |
|---|---|---|
| 30-day mortality, diabetes combined with other SMuRF · 30 days — Diabetic patients who were also smokers vs Without any SMuRF · women | 1.39 (0.92–2.09) | |
| 30-day mortality, diabetes combined with other SMuRF · 30 days — Diabetic patients who were also smokers vs Without any SMuRF · men | 0.89 (0.68–1.17) | |
| 30-day mortality, diabetes combined with other SMuRF · 30 days — Diabetic patients with hypercholesterolaemia vs Without any SMuRF · women | 0.91 (0.66–1.25) | |
| 30-day mortality, diabetes combined with other SMuRF · 30 days — Diabetic patients with hypercholesterolaemia vs Without any SMuRF · men | 0.75 (0.53–1.06) | |
| 30-day mortality, diabetes combined with other SMuRF · 30 days — Diabetic patients with hypertension vs Without any SMuRF · women | 1.14 (0.99–1.32) | |
| 30-day mortality, diabetes combined with other SMuRF · 30 days — Diabetic patients with hypertension vs Without any SMuRF · men | 1.12 (0.96–1.31) | |
| 0.512Relative risk (log scale) |
30-day mortality, diabetes combined with other SMuRF
- When diabetes was combined with other SMuRF, its impact on mortality was diluted
Original publication
The paradox of SMURF-less outcomes and its implication for diabetes. Eur Heart J Qual Care Clin Outcomes. Published 28 January 2026. doi:10.1093/ehjqcco/qcag012
Summarised from the published abstract; every number is checked against it