title: Comparison of outcomes in ST-segment depression and ST-segment elevation myocardial infarction patients treated with emergency PCI: data from a multicentre registry.
abstract: BACKGROUND
  Traditionally, acute myocardial infarction (AMI) has been described as either STEMI (ST-elevation myocardial infarction) or non-STEMI myocardial infarction. This classification is historically related to the use of thrombolytic therapy, which is effective in STEMI. The current era of widespread use of coronary angiography (CAG), usually followed by primary percutaneous coronary intervention (PCI) puts this classification system into question.
  
  
  OBJECTIVE
  To compare the outcomes of patients with STEMI and ST-depression myocardial infarction (STDMI) who were treated with emergency PCI.
  
  
  METHODS
  This multicentre registry enrolled a total of 6 602 consecutive patients with AMI. Patients were divided into the following subgroups: STEMI (n = 3446), STDMI (n = 907), left bundle branch block (LBBB) AMI (n = 241), right bundle branch block (RBBB) AMI (n = 338) and other electrocardiographic (ECG) AMI (n = 1670). Baseline and angiographic characteristics were studied, and revascularisation therapies and in-hospital mortality were analysed.
  
  
  RESULTS
  Acute heart failure was present in 29.5% of the STDMI vs 27.4% of the STEMI patients (p < 0.001). STDMI patients had more extensive coronary atherosclerosis than patients with STEMI (three-vessel disease: 53.1 vs 30%, p < 0.001). The left main coronary artery was an infract-related artery (IRA) in 6.0% of STDMI vs 1.1% of STEMI patients (p < 0.001). TIMI flow 0-1 was found in 35.0% of STDMI vs 66.0% of STEMI patients (p < 0.001). Primary PCI was performed in 88.1% of STEMI (with a success rate of 90.8%) vs 61.8% of STDMI patients (with a success rate of 94.5%) (p = 0.012 for PCI success rates). In-hospital mortality was not significantly different (STDMI 6.3 vs STEMI 5.4%, p = 0.330).
  
  
  CONCLUSIONS
  These data suggest that similar strategies (emergency CAG with PCI whenever feasible) should be applied to both these types of AMI.
authors.affiliation: Third Faculty of Medicine, Charles University, Prague, Czech Republic.
authors.forename: Jiri
authors.initials: J
authors.lastname: Knot
authors.forename: Petr
authors.initials: P
authors.lastname: Kala
authors.forename: Richard
authors.initials: R
authors.lastname: Rokyta
authors.forename: Josef
authors.initials: J
authors.lastname: Stasek
authors.forename: Boyko
authors.initials: B
authors.lastname: Kuzmanov
authors.forename: Ota
authors.initials: O
authors.lastname: Hlinomaz
authors.forename: Jan
authors.initials: J
authors.lastname: Bĕlohlavek
authors.forename: Fili P
authors.initials: FP
authors.lastname: Rohac
authors.forename: Robert
authors.initials: R
authors.lastname: Petr
authors.forename: Dana
authors.initials: D
authors.lastname: Bilkova
authors.forename: Slavejko
authors.initials: S
authors.lastname: Djambazov
authors.forename: Mladen
authors.initials: M
authors.lastname: Grigorov
authors.forename: Petr
authors.initials: P
authors.lastname: Widimsky
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003331:Coronary Vessels / Q000601:surgery; D004562:Electrocardiography; D004632:Emergency Medical Services; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D012042:Registries; D016019:Survival Analysis; D016896:Treatment Outcome