Prediction of Long-Term Outcomes in ST-Elevation Myocardial Infarction and Non-ST Elevation Myocardial Infarction with and without Creatinine Kinase Elevation-Post-Hoc Analysis of the J-MINUET Study.

Shigeru Toyoda,Satoru Suwa,Mafumi Owa,Hisao Ogawa,Masashi Sakuma,Yasuharu Nakama,Keijirou Saku,Teruo Inoue,Minoru Wake,Teruo Noguchi,Atsushi Hirohata,Kengo Tanabe,Nobuaki Kokubu,Yukio Ozaki,Junya Ako,Kazuteru Fujimoto,Ken Kozuma,Shichiro Abe,Toshiaki Mano,Tetsuya Toubaru,Yoshisato Shibata,Atsunori Okamura,Kazuo Kimura,Yoshihiko Saito,Yoshihiro Miyamoto,Takashi Morita,Shigeru Ohshima,Yasuhiro Morita,Masaharu Ishihara,Wataru Shimizu,Hiroshi Funayama,Kenichi Tsujita,Kōichi Nakao

doi:10.3390/jcm9082667

Abstract

Background: A Japanese prospective, nation-wide, multicenter registry (J-MINUET) showed that long-term outcomes were worse in non-ST elevation acute myocardial infarction (NSTEMI), diagnosed by increased cardiac troponin levels, compared to STEMI. This was observed in both non-STEMI with elevated creatine kinase (CK) (NSTEMI+CK) and non-STEMI without elevated CK (NSTEMI-CK). However, predictive factors for long-term outcomes in STEMI, NSTEMI+CK, and NSTEMI-CK have not been elucidated. Methods: Using the Cox proportional hazards model, we determined significant independent predictors of long-term outcomes from a total of 111 parameters evaluated in the J-MINUET study in each of our groups, including STEMI, NSTEMI+CK, and NSTEMI-CK. Then, we calculated the risk score using the regression coefficients for the determined independent predictors for the strict prediction of long-term outcomes. Results: Prognostic factors, as well as composite cardiovascular events and all-cause death, were different between STEMI, NSTEMI+CK, and NSTEMI-CK. Risk scores could effectively and powerfully predict both composite cardiovascular events and all-cause death in each group. Conclusions: The prediction of long-term outcomes using cored parameters of baseline demographics and clinical characteristics is feasible and could prove useful in establishing therapeutic strategies in patients with STEMI, NSTEMI+CK, and NSTEMI-CK.

Highlights

The rapid reperfusion of infarct-related artery is critical for patients with acute myocardial infarction (AMI)
We found that prognostic factors were different between patients with ST-elevation myocardial infarctions (STEMI), non-ST elevation acute myocardial infarction (NSTEMI)+creatine kinase (CK), and NSTEMI-CK
The J-MINUET registry, the latest multicenter registry of Japanese patients with acute myocardial infarctions (MI) diagnosed by the universal definition, showed that long-term outcomes of NSTEMI were worse than those of STEMI in Japanese patients

Summary

Introduction

The rapid reperfusion of infarct-related artery is critical for patients with acute myocardial infarction (AMI). To avoid delays in the diagnosis and treatment of myocardial infarctions (MI), the European Society of Cardiology (ESC)/the American College of Cardiology (ACC) recommended a new definition of AMI in 2010 This Universal Definition is based on cardiac troponin (cTn) as a biomarker of myocardial injury [1]. A prospective, multicenter, nation-wide registry, the Japanese Registry of Acute Myocardial Infarction Diagnosed by Universal Definition (J-MINUET), was conducted to. A Japanese prospective, nation-wide, multicenter registry (J-MINUET) showed that long-term outcomes were worse in non-ST elevation acute myocardial infarction (NSTEMI), diagnosed by increased cardiac troponin levels, compared to STEMI. This was observed in both non-STEMI with elevated creatine kinase (CK) (NSTEMI+CK) and non-STEMI without elevated CK (NSTEMI-CK). Conclusions: The prediction of long-term outcomes using cored parameters of baseline demographics and clinical characteristics is feasible and could prove useful in establishing therapeutic strategies in patients with STEMI, NSTEMI+CK, and NSTEMI-CK

Methods

Results

Conclusion