BACKGROUND: Prior studies of patients presenting with acute myocardial infarction (AMI) without Standard Modifiable Risk Factors (SMuRFs), such as diabetes, dyslipidemia, hypertension, and smoking, reported higher in-hospital but lower long-term mortality than those with SMuRFs. However, the impact of SMuRFs on health status outcomes (patients' symptoms, function, and quality of life) after a first AMI are unknown. METHODS: Data from 2 prospective registries, PREMIER and TRIUMPH, were used to identify patients with no prior history of coronary disease hospitalized at 31 U.S. hospitals for AMI between 2003 and 2008. Serial health status over 12 months was collected using the Seattle Angina Questionnaire (SAQ) Summary Score. Changes in SAQ over 12 months were compared between patients with and without SMuRFs using hierarchical linear mixed models with sequential adjustments for baseline SAQ scores, clinical, and sociodemographic characteristics. RESULTS: Among 4076 patients with a first AMI (mean age 58.4 ± 12.4, 34% female, 22% Black), 569 (14.0%) presented without SMuRFs. Compared with patients with SMuRFs, those without SMuRFs were more likely to be male, White, have higher income and education, fewer depressive symptoms, and higher baseline SAQ Summary Scores (83.5 ± 13.2 vs. 79.6 ± 16.5). After adjusting for baseline SAQ scores, patients without SMuRFs had larger SAQ Summary Score improvements at 12 months than those with SMuRFs (adjusted difference between groups = 2.61 points, 95% CI: 1.29-3.93), but sequential adjustment for clinical and socioeconomic characteristics attenuated this difference (1.69 points, 95% CI 0.40-1.97). CONCLUSIONS: Among AMI patients, those without modifiable risk factors had similar health status at 12-months as compared with those having modifiable cardiovascular risk factors, which should provide reassurance to those with less targets for secondary prevention.