ST-segment elevation versus non-ST-segment elevation myocardial infarction in current smokers after newer-generation
Yong Hoon Kim1, Ae-Young Her1, Myung Ho Jeong2
1Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea.
Insights
Outcomes were similar for current smokers with ST-segment elevation myocardial infarction (STEMI) and non-STEMI after newer drug-eluting stent procedures. This study found no significant differences in major adverse cardiac events at one month and two years post-PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Limited data exist on comparative outcomes for ST-segment elevation myocardial infarction (STEMI) versus non-STEMI (NSTEMI) patients who smoke.
- Newer-generation drug-eluting stents (DESs) have improved outcomes in acute myocardial infarction (AMI).
Purpose of the Study:
- To compare 2-year major clinical outcomes between STEMI and NSTEMI patients who are current smokers undergoing percutaneous coronary intervention (PCI) with newer-generation DESs.
Main Methods:
- A total of 8357 AMI patients were analyzed, divided into STEMI (n=5124) and NSTEMI (n=3233) groups.
- Propensity score-matched (PSM) analysis created 2250 matched pairs.
- Primary endpoint: Major Adverse Cardiac Events (MACE) including all-cause death, recurrent myocardial infarction (re-MI), or repeat revascularization. Secondary endpoints included MACE components and stent thrombosis.
Main Results:
- After PSM, no significant differences in MACE were observed between STEMI and NSTEMI groups at 1 month (P=.183) or 2 years (P=.655).
- Individual MACE components, including all-cause death, cardiac death, re-MI, and stent thrombosis, also showed no significant differences between the groups at 2 years.
- Multivariate analysis confirmed these findings.
Conclusions:
- In current smokers treated with newer-generation DESs, STEMI and NSTEMI patients exhibit similar major clinical outcomes at 1 month and 2 years post-PCI.
- These findings suggest that smoking status may be a more critical factor than STEMI vs. NSTEMI classification in this specific patient cohort.
- Further research is warranted to validate these observations.
Abstract:
We compared the 2-year major clinical outcomes between ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) in patients who are current smokers who underwent successful percutaneous coronary intervention (PCI) with newer-generation drug-eluting stents (DESs). The availability of data in this regard is limited.A total of 8357 AMI patients were included and divided into 2 groups: the STEMI group (n = 5124) and NSTEMI group (n = 3233). The primary endpoint was the occurrence of major adverse cardiac events (MACE), defined as all-cause death, recurrent myocardial infarction (re-MI), or coronary repeat revascularization. The secondary endpoints were the cumulative incidences of the individual components of MACE and stent thrombosis (definite or probable).After propensity score-matched (PSM) analysis, 2 PSM groups (2250 pairs, C-statistics = 0.795) were generated. In the PSM patients, both for 1 month and at 2 years, the cumulative incidence of MACE (P = .183 and P = .655, respectively), all-cause death, cardiac death, re-MI, all-cause death or MI, any repeat revascularization, and stent thrombosis (P = .998 and P = .341, respectively) was not significantly different between the STEMI and NSTEMI groups. In addition, these results were confirmed using multivariate analysis.In the era of contemporary newer-generation DESs, both during 1 month and at 2 years after index PCI, the major clinical outcomes were not significantly different between the STEMI and NSTEMI groups confined to the patients who are current smokers. However, further research is needed to confirm these results.
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