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Difference in the in-hospital prognosis between ST-segment elevation myocardial infarction and non-ST-segment
Motoki Fukutomi1, Kensaku Nishihira2, Satoshi Honda2
1Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Japan.
Insights
ST-segment elevation myocardial infarction (STEMI) has worse outcomes than non-ST-segment elevation myocardial infarction (NSTEMI) in high Killip class patients, particularly the elderly. Younger patients showed no significant difference in short-term outcomes between STEMI and NSTEMI.
Area of Science:
- Cardiology
- Acute Myocardial Infarction Research
- Geriatric Cardiology
Background:
- ST-segment elevation myocardial infarction (STEMI) generally has a worse short-term prognosis than non-ST-segment elevation myocardial infarction (NSTEMI).
- The comparative outcomes of STEMI versus NSTEMI in patients with high Killip class (II-IV) have remained unclear.
- High Killip class indicates severe left ventricular dysfunction and carries a poor prognosis in acute myocardial infarction (AMI).
Purpose of the Study:
- To investigate the short-term outcomes of STEMI compared to NSTEMI in patients presenting with high Killip class (II-IV).
- To evaluate the influence of age on the comparative outcomes between STEMI and NSTEMI in this high-risk AMI population.
Main Methods:
- Analysis of 3704 acute myocardial infarction patients with Killip II-IV class from the Japan Acute Myocardial Infarction Registry.
- Comparison of short-term outcomes, including in-hospital mortality, between STEMI (n=2943) and NSTEMI (n=761) groups.
- Subgroup analysis based on age: <80 years and ≥80 years.
Main Results:
- Overall, no significant difference in in-hospital mortality between STEMI and NSTEMI groups (20.0% vs 17.1%, p=0.065).
- In patients <80 years, in-hospital mortality was similar between STEMI (15.7%) and NSTEMI (15.2%) groups (p=0.807).
- In patients ≥80 years, STEMI was associated with significantly higher in-hospital mortality (29.3% vs 19.8%, p=0.001) and cardiac mortality (23.3% vs 15.0%, p=0.002) compared to NSTEMI.
Conclusions:
- In high Killip class AMI patients, STEMI does not confer worse short-term outcomes than NSTEMI in younger individuals.
- Elderly patients (≥80 years) with high Killip class AMI experience significantly worse short-term outcomes with STEMI compared to NSTEMI.
- Further research is needed to identify prognostic factors and optimize intensive care for this high-risk elderly AMI subgroup.
Background:
ST-segment elevation myocardial infarction is known to be associated with worse short-term outcome than non-ST-segment elevation myocardial infarction. However, whether or not this trend holds true in patients with a high Killip class has been unclear.
Methods:
We analyzed 3704 acute myocardial infarction patients with Killip II-IV class from the Japan Acute Myocardial Infarction Registry and compared the short-term outcomes between ST-segment elevation myocardial infarction (n = 2943) and non-ST-segment elevation myocardial infarction (n = 761). In addition, we also performed the same analysis in different age subgroups: <80 years and ≥80 years.
Results:
In the overall population, there were no significant difference in the in-hospital mortality (20.0% vs 17.1%, p = 0.065) between ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction groups. Patients <80 years of age also showed no difference in the in-hospital mortality (15.7% vs 15.2%, p = 0.807) between ST-segment elevation myocardial infarction (n = 2001) and non-ST-segment elevation myocardial infarction (n = 453) groups, whereas among those ≥80 years of age, ST-segment elevation myocardial infarction (n = 942) was associated with significantly higher in-hospital mortality (29.3% vs 19.8%, p = 0.001) and in-hospital cardiac mortality (23.3% vs 15.0%, p = 0.002) than non-ST-segment elevation myocardial infarction (n = 308). After adjusting for covariates, ST-segment elevation myocardial infarction was a significant predictor for in-hospital mortality (odds ratio 2.117; 95% confidence interval, 1.204-3.722; p = 0.009) in patients ≥80 years of age.
Conclusion:
Among cases of acute myocardial infarction with a high Killip class, there was no marked difference in the short-term outcomes between ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction in younger patients, while ST-segment elevation myocardial infarction showed worse short-term outcomes in elderly patients than non-ST-segment elevation myocardial infarction. Future study identifying the prognostic factors for the specific anticipation intensive cares is needed in this high-risk group.