Outcomes in patients with acute and stable coronary syndromes; insights from the prospective NOBORI-2 study
Farzin Fath-Ordoubadi1, Erik Spaepen2, Magdi El-Omar1
1Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom.
Insights
Patients undergoing percutaneous coronary intervention (PCI) for non-ST-elevation myocardial infarction (NSTEMI) face higher risks of cardiac mortality and major adverse cardiac events (MACE). ST-elevation myocardial infarction (STEMI) patients show outcomes similar to stable angina patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Limited contemporary data exists on mortality and major adverse cardiac events (MACE) after percutaneous coronary intervention (PCI) for various coronary artery disease (CAD) presentations.
- Understanding these outcomes is crucial for optimizing patient management and risk stratification.
Purpose of the Study:
- To evaluate and compare mortality and MACE outcomes in patients undergoing PCI for ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and stable angina.
- To analyze data from the Nobori-2 study to provide insights into the comparative effectiveness of PCI across different CAD manifestations.
Main Methods:
- Analysis of data from 1909 patients who underwent PCI, categorized into stable angina (1332), STEMI (248), and NSTEMI (329) cohorts.
- Clinical endpoints included cardiac mortality and MACE (composite of cardiac death, myocardial infarction, and target vessel revascularization).
- Cox multivariate analysis was employed to adjust for clinical demographics and the Charlson co-morbidity index.
Main Results:
- The NSTEMI cohort exhibited a higher age-adjusted Charlson co-morbidity index compared to the stable angina cohort.
- Cardiac mortality was significantly higher in the NSTEMI group versus stable angina (HR 2.31, p=0.028) after multivariate analysis.
- MACE within 180 days was also significantly higher for NSTEMI versus stable angina (HR 2.34, p=0.012).
Conclusions:
- Longer-term cardiac mortality and MACE are significantly worse for patients undergoing PCI for NSTEMI, even after adjusting for clinical factors.
- Patients undergoing PCI for STEMI demonstrated favorable longer-term prognosis, with outcomes comparable to those with stable angina.
- These findings highlight differential risk profiles associated with PCI for various CAD presentations.
Background:
Contemporary data remains limited regarding mortality and major adverse cardiac events (MACE) outcomes in patients undergoing PCI for different manifestations of coronary artery disease.
Objectives:
We evaluated mortality and MACE outcomes in patients treated with PCI for STEMI (ST-elevation myocardial infarction), NSTEMI (non ST-elevation myocardial infarction) and stable angina through analysis of data derived from the Nobori-2 study.
Methods:
Clinical endpoints were cardiac mortality and MACE (a composite of cardiac death, myocardial infarction and target vessel revascularization).
Results:
1909 patients who underwent PCI were studied; 1332 with stable angina, 248 with STEMI and 329 with NSTEMI. Age-adjusted Charlson co-morbidity index was greatest in the NSTEMI cohort (3.78±1.91) and lowest in the stable angina cohort (3.00±1.69); P<0.0001. Following Cox multivariate analysis cardiac mortality was independently worse in the NSTEMI vs the stable angina cohort (HR 2.31 (1.10-4.87), p = 0.028) but not significantly different for STEMI vs stable angina cohort (HR 0.72 (0.16-3.19), p = 0.67). Similar observations were recorded for MACE (<180 days) (NSTEMI vs stable angina: HR 2.34 (1.21-4.55), p = 0.012; STEMI vs stable angina: HR 2.19 (0.97-4.98), p = 0.061.
Conclusions:
The longer-term Cardiac mortality and MACE were significantly worse for patients following PCI for NSTEMI even after adjustment of clinical demographics and Charlson co-morbidity index whilst the longer-term prognosis of patients following PCI STEMI was favorable, with similar outcomes as those patients with stable angina following PCI.
More Related Videos
10:03Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome I: Introduction
01:26Acute Coronary Syndrome V: Nursing Management
01:30Coronary Artery Disease III: Clinical Manifestations
01:26Coronary Artery Disease II: Pathophysiology