Long-Term Outcomes of Non-ST-Elevation Myocardial Infarction Without Creatine Kinase Elevation　- The J-MINUET Study.
According to troponin-based criteria of myocardial infarction (MI), patients without elevation of creatine kinase (CK), formerly classified as unstable angina (UA), are now diagnosed as non-ST-elevation MI (NSTEMI), but little is known about their outcomes.



Between July 2012 and March 2014, 3,283 consecutive patients with MI were enrolled. Clinical follow-up data were obtained up to 3 years. The primary endpoint was a composite of all-cause death, non-fatal MI, non-fatal stroke, cardiac failure and urgent revascularization for UA. There were 2,262 patients with ST-elevation MI (STEMI), 563 NSTEMI with CK elevation (NSTEMI+CK) and 458 NSTEMI without CK elevation (NSTEMI-CK). From day 0, Kaplan-Meier curves for the primary endpoint began to diverge in favor of NSTEMI-CK for up to 30 days. The 30-day event rate was significantly lower in patients with NSTEMI-CK (3.3%) than in STEMI (8.6%, P<0.001) and NSTEMI+CK (9.9%, P<0.001). Later, the event curves diverged in favor of STEMI. The event rate from 31 days to 3 years was significantly lower in patients with STEMI (19.8%) than in NSTEMI+CK (33.6%, P<0.001) and NSTEMI-CK (34.2%, P<0.001). Kaplan-Meier curves from 31 days to 3 years were almost identical between NSTEMI+CK and NSTEMI-CK (P=0.91).



Despite smaller infarct size and better short-term outcomes, long-term outcomes of NSTEMI-CK after convalescence were as poor as those for NSTEMI+CK and worse than for STEMI.
Division of Coronary Artery Disease, Hyogo College of Medicine.
Masaharu
M
Ishihara
Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center.
Koichi
K
Nakao
Department of Cardiology, Fujita Health University.
Yukio
Y
Ozaki
Division of Cardiology, Yokohama City University Medical Center.
Kazuo
K
Kimura
Department of Cardiovascular Medicine, Kitasato University Hospital.
Junya
J
Ako
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center.
Teruo
T
Noguchi
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center.
Masashi
M
Fujino
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center.
Satoshi
S
Yasuda
Department of Cardiology, Juntendo University Shizuoka Hospital.
Satoru
S
Suwa
Department of Cardiology, National Hospital Organization Kumamoto Medical Center.
Kazuteru
K
Fujimoto
Department of Cardiology, Hiroshima City Hospital.
Yasuharu
Y
Nakama
Division of Cardiology, Osaka General Medical Center.
Takashi
T
Morita
Department of Cardiovascular Medicine, Nippon Medical School Hospital.
Wataru
W
Shimizu
First Department of Internal Medicine, Nara Medical University.
Yoshihiko
Y
Saito
Department of Cardiology, The Sakakibara Heart Institute of Okayama.
Atsushi
A
Hirohata
Department of Cardiology, Ogaki Municipal Hospital.
Yasuhiro
Y
Morita
Department of Cardiovascular Medicine, Dokkyo Medical University.
Teruo
T
Inoue
Department of Cardiology, Sakurabashi Watanabe Hospital.
Atsunori
A
Okamura
Cardiovascular Center, Kansai Rosai Hospital.
Masaaki
M
Uematsu
Department of Cardiology, Okinawa Chubu Hospital.
Kazuhito
K
Hirata
Division of Cardiology, Mitsui Memorial Hospital.
Kengo
K
Tanabe
Department of Cardiology, Miyazaki Medical Association Hospital.
Yoshisato
Y
Shibata
Department of Cardiovascular Medicine, Suwa Red Cross Hospital.
Mafumi
M
Owa
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University.
Kenichi
K
Tsujita
Department of Integrated Medicine, Saitama Medical Center Jichi Medical University.
Hiroshi
H
Funayama
Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University.
Nobuaki
N
Kokubu
Department of Cardiology, Teikyo University.
Ken
K
Kozuma
Department of Cardiology, Sakakibara Heart Institute.
Tetsuya
T
Tobaru
Department of Cardiology, Gunma Prefectural Cardiovascular Center.
Shigeru
S
Oshima
Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center.
Michikazu
M
Nakai
Department of Preventive Cardiology, National Cerebral and Cardiovascular Center.
Kunihiro
K
Nishimura
Department of Preventive Cardiology, National Cerebral and Cardiovascular Center.
Yoshihiro
Y
Miyamoto
National Cerebral and Cardiovascular Center.
Hisao
H
Ogawa
D000368:Aged; D000369:Aged, 80 and over; D003402:Creatine Kinase / Q000097:blood; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D011446:Prospective Studies; D020521:Stroke / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000628:therapy; D015996:Survival Rate; D013997:Time Factors
D003402:Creatine Kinase
Cardiac troponin; Creatine kinase; Multicenter registry; Myocardial infarction; Prognosis