title: Long-term mortality of patients undergoing cardiac catheterization for ST-elevation and non-ST-elevation myocardial infarction.
abstract: BACKGROUND
  There are limited contemporary data comparing long-term outcomes after cardiac catheterization for ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI).
  
  
  RESULTS
  We studied patients undergoing cardiac catheterization for STEMI (n=2413) and NSTEMI (n=1974) between 1999 and 2005 with at least 1 significant coronary lesion > or =75%. We compared adjusted mortality rates over restricted time intervals and the differential impact of early revascularization on mortality stratified by ST-elevation status. Between 1999 and 2007, 1274 patients died, with a median follow-up of 4 years. A piece-wise analysis showed a higher adjusted mortality risk for STEMI during the first 2 months (adjusted hazard ratio, 1.85; 95% confidence interval, 1.45 to 2.38) and a lower adjusted mortality risk for STEMI after 2 months (adjusted hazard ratio, 0.68; 95% confidence interval, 0.59 to 0.83). Compared with late or no revascularization, early revascularization was associated with a lower adjusted risk of mortality for both STEMI (adjusted hazard ratio, 0.73; 95% confidence interval, 0.58 to 0.90) and NSTEMI (adjusted hazard ratio, 0.76; 95% confidence interval, 0.65 to 0.89) (P for interaction=0.22).
  
  
  CONCLUSIONS
  Among a contemporary cohort of acute MI patients with significant coronary disease during cardiac catheterization, STEMI was associated with a higher risk of short-term mortality, but NSTEMI was associated with a higher risk of long-term mortality. Early revascularization was associated with a similar improvement in long-term outcomes for both STEMI and NSTEMI. These data suggest that in clinical investigations of early revascularization among patients with NSTEMI, extended follow-up may be necessary to demonstrate treatment benefit.
authors.affiliation: MBBS, MHS, National University Heart Center, 5 Lower Kent Ridge Road, Singapore, Singapore 119074. chanyymark@gmail.com
authors.forename: Mark Y
authors.initials: MY
authors.lastname: Chan
authors.forename: Jie L
authors.initials: JL
authors.lastname: Sun
authors.forename: L Kristin
authors.initials: LK
authors.lastname: Newby
authors.forename: Linda K
authors.initials: LK
authors.lastname: Shaw
authors.forename: Min
authors.initials: M
authors.lastname: Lin
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
authors.forename: David F
authors.initials: DF
authors.lastname: Kong
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Roe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D003327:Coronary Disease / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors