Abstract
BackgroundThe detailed causes of death in non–ST-segment–elevation myocardial infarction (NSTEMI) have not been adequately evaluated compared to those in ST-segment elevation myocardial infarction (STEMI).MethodsThe study population was 6,228 AMI patients who underwent percutaneous coronary intervention (STEMI: 4,625 patients and NSTEMI: 1,603 patients). The primary outcome was all-cause death.ResultsWithin 6 months after AMI, the adjusted mortality risk was not significantly different between NSTEMI patients and STEMI patients (HR: 0.83, 95%CI: 0.67–1.03, P = 0.09). Regarding the causes of death within 6 months after AMI, mechanical complications more frequently occurred in STEMI patients than in NSTEMI patients, while proportions of post resuscitation status on arrival and heart failure were higher in in NSTEMI patients than in STEMI patients. Beyond 6 months after AMI, the adjusted mortality risk of NSTEMI relative to STEMI was not significantly different. (HR: 1.04, 95%CI: 0.90–1.20, P = 0.59). Regarding causes of death beyond 6 months after AMI, almost half of deaths were cardiovascular causes in both groups, and breakdown of causes of death was similar between NSTEMI and STEMI.ConclusionThe mortality risk within and beyond 6 months after AMI were not significantly different between STEMI patients and NSTEMI patients after adjusting confounders. Deaths due to post resuscitation status and heart failure were more frequent in NSTEMI within 6 months after AMI.
Highlights
Primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) has been widely performed worldwide and mortality of STEMI patients has been improved [1,2,3,4,5] Non ST-segment elevation myocardial infarction (NSTEMI) is different from STEMI in many aspects including pathophysiology and treatment [4, 6, 7]
The study population consisted of 6,228 acute myocardial infarction (AMI) patients who underwent PCI after excluding those patients who refused study participation (N = 21) and those who underwent coroanry artery bypass grafting (CABG) (N = 221) (Fig 1)
The main findings of this study were as follows; 1) The mortality risk within 6 months after AMI was not significantly different between STEMI patients and non–ST-segment–elevation myocardial infarction (NSTEMI) patients; 2) Within 6 months after AMI, deaths due to post resuscitation status and heart failure (HF) were more frequent in NSTEMI patients than in STEMI patients, while deaths due to mechanical complication and cardiogenic shock were more frequent in STEMI patients than in NSTEMI patients; 3) The mortality risk of NSTEMI relative to STEMI beyond 6 months after AMI was no longer significant after adjusting confounders; 4) Approximately half of deaths beyond 6 months were cardiovascular death in both STEMI and NSTEMI patients, and detailed causes of deaths were similar in NSTEMI and STEMI patients
Summary
Primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) has been widely performed worldwide and mortality of STEMI patients has been improved [1,2,3,4,5] Non ST-segment elevation myocardial infarction (NSTEMI) is different from STEMI in many aspects including pathophysiology and treatment [4, 6, 7]. Clinical outcomes of NSTEMI patients may be different from those of STEMI patients. The reasons for the higher mortality risk and the causes of death in NSTEMI patients have not been fully evaluated yet. Sought to compare short- and long-term clinical outcomes and the causes of death between NSTEMI and STEMI in a large-scale Japanese cohort study. The detailed causes of death in non–ST-segment–elevation myocardial infarction (NSTEMI) have not been adequately evaluated compared to those in ST-segment elevation myocardial infarction (STEMI)
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