Comparison of Short- and Long-Term Prognosis between ST-Elevation and Non-ST-Elevation Myocardial Infarction
Frédéric Bouisset1,2, Jean-Bernard Ruidavets2, Jean Dallongeville3
1Department of Cardiology, Rangueil University Hospital, 31059 Toulouse, France.
Insights
ST-elevation myocardial infarction (STEMI) patients face higher short-term mortality than non-ST-elevation myocardial infarction (non-STEMI) patients. However, long-term prognosis is similar for both acute coronary syndrome (ACS) types after one year.
Area of Science:
- Cardiology
- Clinical Research
- Public Health
Background:
- Limited and conflicting data exist on long-term outcomes for different acute coronary syndrome (ACS) types.
- Previous studies on ST-elevation myocardial infarction (STEMI) versus non-ST-elevation myocardial infarction (non-STEMI) prognoses are outdated.
Purpose of the Study:
- To compare short-term (28-day) and long-term (10-year) mortality rates between STEMI and non-STEMI patients.
- To analyze mortality trends in ACS patients over a decade.
Main Methods:
- A cohort of 1822 patients with first ACS in 2006 from the French MONICA registry was analyzed.
- Short-term (28-day) and long-term (10-year) mortality were compared between STEMI and non-STEMI groups.
- Statistical adjustments were made for potential confounding factors.
Main Results:
- At 28 days, STEMI patients had higher mortality (6.7%) than non-STEMI patients (4.7%), significantly so after adjustment (OR=0.58, p=0.03).
- At 10 years, mortality rates were similar (STEMI: 19.6%, non-STEMI: 22.8%, p=0.11), with no significant difference after adjustment (OR=1.07, p=0.59).
- Annual mortality stabilized around 1.7% from year 2 to year 10 post-ACS.
Conclusions:
- STEMI is associated with a worse prognosis within 28 days compared to non-STEMI.
- Long-term vital prognosis (10 years) is comparable between STEMI and non-STEMI patients.
- Post-ACS, patients develop stable coronary artery disease with similar annual mortality rates (~2%) from the second year onward, irrespective of initial ACS type.
Background:
Available data comparing long-term prognosis according to the type of acute coronary syndrome (ACS) are scarce, contradictory, and outdated. Our aim was to compare short- and long-term mortality in ST-elevated (STEMI) and non-ST-elevated myocardial infarction (non-STEMI) ACS patients.
Methods:
Patients presenting with an inaugural ACS during the year 2006 and living in one of the three areas in France covered by the Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) registry were included.
Results:
A total of 1822 patients with a first ACS-1121 (61.5%) STEMI and 701 (38.5%) non-STEMI-were included in the study. At the 28-day follow-up, the mortality rates were 6.7% and 4.7% (p = 0.09) for STEMI and non-STEMI patients, respectively, and after adjustment of potential confounding factors, the 28-day probability of death was significantly lower for non-STEMI ACS patients (Odds Ratio = 0.58 (0.36-0.94), p = 0.03). At the 10-year follow-up, the death rates were 19.6% and 22.8% (p = 0.11) for STEMI and non-STEMI patients, respectively, and after adjustment of potential confounding factors, the 10-year probability of death did not significantly differ between non-STEMI and STEMI events (OR = 1.07 (0.83-1.38), p = 0.59). Over the first year, the mortality rate was 7.2%; it then decreased and stabilized at 1.7% per year between the 2nd and 10th year following ACS.
Conclusion:
STEMI patients have a worse vital prognosis than non-STEMI patients within 28 days following ACS. However, at the 10-year follow-up, STEMI and non-STEMI patients have a similar vital prognosis. From the 2nd year onwards following the occurrence of a first ACS, the patients become stable coronary artery disease patients with an annual mortality rate in the 2% range, regardless of the type of ACS they initially present with.
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