Higher Long-Term Mortality in Patients with Non-ST-Elevation Myocardial Infarction than ST-Elevation Myocardial
Xiongyi Han1,2, Liyan Bai1,2, Myung Ho Jeong3
1Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea.
Insights
Patients with non-ST-elevation myocardial infarction (NSTEMI) had higher 3-year mortality than those with ST-elevation myocardial infarction (STEMI). Key risk factors for NSTEMI mortality included low ejection fraction and no percutaneous coronary intervention.
Area of Science:
- Cardiology
- Clinical Research
- Public Health
Background:
- Myocardial infarction (MI) is a leading cause of death globally.
- Distinguishing between ST-elevation MI (STEMI) and non-ST-elevation MI (NSTEMI) is crucial for prognosis and treatment.
- Long-term mortality and risk factors following MI require continuous investigation.
Purpose of the Study:
- To compare 3-year post-discharge mortality rates between NSTEMI and STEMI patients.
- To identify specific mortality risk factors for both NSTEMI and STEMI cohorts.
Main Methods:
- Analysis of 12,271 acute myocardial infarction patients from the Korea Acute Myocardial Infarction-National Institute of Health (KAMIR-NIH) registry (2011-2015).
- Stratification into STEMI (n=5828) and NSTEMI (n=6443) groups.
- Comparison of 3-year all-cause and cardiac mortality, and evaluation of associated risk factors.
Main Results:
- NSTEMI patients exhibited higher cumulative 3-year all-cause (10.9% vs. 5.8%) and cardiac mortality (6.6% vs. 3.5%) compared to STEMI patients.
- In NSTEMI, mortality risk factors included low left ventricular ejection fraction (<40%), absence of percutaneous coronary intervention (PCI), older age (≥65 years), and low hemoglobin (<12 g/dL).
- In STEMI, risk factors for mortality were older age, low glomerular filtration rate (<60 mL/min/1.73 m²), low LVEF, high heart rate (>100 bpm), no PCI, and low hemoglobin.
Conclusions:
- NSTEMI is associated with significantly higher 3-year mortality than STEMI.
- Low LVEF and lack of PCI are primary mortality predictors in NSTEMI.
- Older age and renal dysfunction are key long-term mortality risks in STEMI.
Purpose:
This study aimed to compare mortality rates after discharge between the patients with non-ST-elevation myocardial infarction (NSTEMI) and those with ST-elevation myocardial infarction (STEMI), and identify each mortality risk factors in these two types of myocardial infarction.
Materials And Methods:
Between 2011 and 2015, 13105 consecutive patients were enrolled in the Korea Acute Myocardial Infarction-National Institute of Health registry (KAMIR-NIH); 12271 patients with acute myocardial infarction met the inclusion criteria and were further stratified into the STEMI (n=5828) and NSTEMI (n=6443) groups. The occurrence of mortality and cardiac mortality at 3 years were compared between groups, and the factors associated with mortality for NSTEMI and STEMI were evaluated.
Results:
The comparison between these two groups and long-term follow-up outcomes showed that the cumulative rates of all-cause and cardiac mortality were higher in the NSTEMI group than in the STEMI group [all-cause mortality: 10.9% vs. 5.8%; hazards ratio (HR), 0.464; 95% confidence interval (CI), 0.359-0.600, p<0.001; cardiac mortality: 6.6% vs. 3.5%, HR, 0.474; 95% CI, 0.344-0.654, p<0.001, respectively). In the NSTEMI group, low left ventricular ejection fraction (LVEF; <40%), no percutaneous coronary intervention (PCI), old age (≥65 years), and low hemoglobin level (<12 g/dL) were identified as risk factors for 3-year mortality. In the STEMI group, old age, low glomerular filtration rate (<60 mL/min/1.73 m²), low LVEF, high heart rate (>100 beats/min), no PCI, and low hemoglobin level were identified as the risk factors for 3-year mortality.
Conclusion:
The NSTEMI group had higher mortality compared to the STEMI group during the 3-year clinical follow-up after discharge. Low LVEF and no PCI were the main risk factors for mortality in the NSTEMI group. In contrast, old age and renal dysfunction were the risk factors for long-term mortality in the STEMI group.
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