Comparison of outcomes in ST-segment depression and ST-segment elevation myocardial infarction patients treated with
Jiri Knot1, Petr Kala, Richard Rokyta
1Third Faculty of Medicine, Charles University, Prague, Czech Republic.
Insights
ST-elevation myocardial infarction (STEMI) and ST-depression myocardial infarction (STDMI) patients treated with percutaneous coronary intervention (PCI) showed similar in-hospital mortality. Both acute heart failure and coronary atherosclerosis were more prevalent in STDMI patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Research
Background:
- Traditional acute myocardial infarction (AMI) classification into STEMI and non-STEMI is challenged by current reperfusion strategies.
- Widespread use of coronary angiography (CAG) and primary percutaneous coronary intervention (PCI) necessitates re-evaluation of diagnostic and treatment paradigms.
Purpose of the Study:
- To compare outcomes of STEMI and ST-depression myocardial infarction (STDMI) patients undergoing emergency PCI.
- To evaluate the efficacy of current treatment strategies across different AMI electrocardiographic presentations.
Main Methods:
- A multicentre registry included 6,602 AMI patients, categorized by ECG findings: STEMI, STDMI, LBBB, RBBB, and other ECG patterns.
- Analysis encompassed baseline characteristics, angiographic findings, revascularization therapies, and in-hospital mortality.
Main Results:
- STDMI patients exhibited higher rates of acute heart failure (29.5% vs 27.4%), more extensive coronary atherosclerosis (three-vessel disease: 53.1% vs 30%), and left main coronary artery involvement (6.0% vs 1.1%) compared to STEMI.
- Primary PCI success rates were high in both groups (STEMI: 90.8%, STDMI: 94.5%), with no significant difference in in-hospital mortality (STEMI: 5.4%, STDMI: 6.3%).
Conclusions:
- Current data suggest that emergency CAG with PCI, when feasible, should be a consistent strategy for both STEMI and STDMI.
- The findings support a unified interventional approach for these distinct AMI presentations, optimizing patient outcomes.
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.
Objectives:
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).
Conclusion:
These data suggest that similar strategies (emergency CAG with PCI whenever feasible) should be applied to both these types of AMI.
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