Early- and late-term clinical outcome and their predictors in patients with ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction.
BACKGROUND
The disparity between ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) remains controversial. We compared clinical outcomes and prognostic factors between STEMI and NSTEMI using large-scale registry data.


METHODS
We recruited 28,421 patients with STEMI (n=16,607) and NSTEMI (n=11,814) between November 2005 and April 2010 from a nationwide registry in Korea. We performed landmark analysis of cardiac death, recurrent acute myocardial infarction (re-AMI), revascularization, and major adverse cardiac events (MACE) at 30 days (early term) and 1 year (late term) after admission.


RESULTS
Patients with NSTEMI had a greater number of co-morbidities than STEMI patients. Early term MACE (6.9% vs. 4.5%, p<0.001) and cardiac death (6.1% vs. 3.7%, p<0.001) were higher in STEMI patients. However, late-term MACE (8.0% vs. 9.1%, p=0.007), cardiac death (1.9% vs. 2.6%, p=0.001), and re-AMI (0.6% vs. 1.3%, p<0.001) were lower in the STEMI group. The independent predictors of cardiac death were old age, renal dysfunction, LV dysfunction, Killip class, post-thrombolysis in myocardial infarction (TIMI) flow, and major bleeding in both groups. Female gender, previous ischemic heart disease, diabetes, current smoking, multivessel disease, and body mass index were MI type- or time-dependent predictors.


CONCLUSIONS
The STEMI group displayed poor early term clinical outcome, whereas the NSTEMI group displayed poor late-term clinical outcome. The STEMI and NSTEMI groups had different predictor profiles for cardiac death, suggesting that different strategies are required for improving the late-term outcome of STEMI and NSTEMI patients.
Konyang University Hospital, Daejeon, Republic of Korea.
Hyun-Woong
HW
Park
Chang-Hwan
CH
Yoon
Si-Hyuck
SH
Kang
Dong-Ju
DJ
Choi
Hyo-Soo
HS
Kim
Myeong Chan
MC
Cho
Young Jo
YJ
Kim
Shung Chull
SC
Chae
Jung Han
JH
Yoon
Hyeon-Cheol
HC
Gwon
Young-Keun
YK
Ahn
Myung-Ho
MH
Jeong
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D009204:Myocardial Revascularization / Q000379:methods; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012042:Registries; D056910:Republic of Korea / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
Acute myocardial infarction; NSTEMI; Prognosis; Risk factor; STEMI