High-risk non-ST-segment elevation myocardial infarction versus ST-segment elevation myocardial infarction: same behaviour and outcome?
Despite advances in the treatment of acute coronary syndromes (ACS) a large proportion of patients do not receive adequate treatment. In most cases, myocardial infarction with ST-segment elevation myocardial infarction (STEMI) is associated with thrombotic occlusion of a major coronary artery, and 30-day mortality is higher than for patients with non-ST-segment elevation myocardial infarction (NSTEMI). In patients with NSTEMI, however, the mortality rate increases after discharge, becoming close to that seen in STEMI patients at 6 months. Whereas patients with STEMI usually undergo emergent revascularization, the clinical scenario in NSTEMI is extremely variable and, in most cases, high-risk patients do not undergo coronary angiography at the times recommended in the European Society of Cardiology guidelines. Unlike NSTEMI, STEMI is associated with a very high risk of mortality in 30% of cases, whereas the remaining 70% of cases have a short-term mortality risk of less than 5%. The application of accurate models for risk prediction may significantly improve survival in these patients, thus avoiding emergent revascularization in low to medium-risk patients. This approach may lead to a redistribution of care across the spectrum of ACS, thus giving priority when the risk/benefit ratio is higher, independent of electrocardiogram results at presentation.
Manari
Antonio
A
U.O. Cardiologia Interventistica, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. manari.antonio@asmn.re.it
Albiero
Remo
R
De Servi
Stefano
S
D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D004562:Electrocardiography; D019317:Evidence-Based Medicine; D017052:Hospital Mortality; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome