One-Year Prognostic Differences and Management Strategies between ST-Elevation and Non-ST-Elevation Myocardial
Luigi Spadafora1,2, Paola Pastena3,4, Stefano Cacciatore5,6
1Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy. luigispadafora167@gmail.com.
Insights
This study found that ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) have similar 1-year prognoses. Differences in reinfarction risk are linked to patient characteristics and treatment, not the infarct type.
Area of Science:
- Cardiology
- Clinical Research
- Public Health
Background:
- Prognostic differences between ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) post-discharge are debated.
- Real-world data is crucial for understanding these outcomes.
Purpose of the Study:
- To compare 1-year clinical outcomes between STEMI and NSTEMI patients.
- To identify factors influencing prognosis in acute coronary syndrome.
Main Methods:
- Analysis of 21,789 acute coronary syndrome patients from the PRAISE registry (2003-2019).
- Comparison of clinical characteristics, discharge medications, and 1-year outcomes (mortality, re-infarction, bleeding).
- Adjustment for confounders using multivariable logistic regression and propensity score matching.
Main Results:
- STEMI (12,365 patients) vs. NSTEMI (9424 patients) cohorts analyzed.
- NSTEMI patients had more comorbidities; STEMI patients received more guideline-directed medical therapy at discharge.
- One-year outcomes were comparable; adjusted re-infarction risk was similar between groups.
Conclusions:
- STEMI and NSTEMI patients exhibit similar 1-year prognoses after adjusting for clinical and therapeutic variables.
- Observed differences in reinfarction risk are primarily attributed to baseline patient factors and treatment received, not the infarct classification itself.
Introduction:
Whether ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) carry distinct prognoses after discharge remains a matter of debate. This study aimed to compare 1-year clinical outcomes between patients with STEMI and NSTEMI in a large, real-world cohort.
Methods:
Among 23,270 patients with acute coronary syndrome enrolled in the international PRAISE registry between 2003 and 2019, we included 21,789 patients with a diagnosis of either STEMI or NSTEMI. Clinical characteristics, discharge medications, and outcomes at 1 year were analyzed. The primary outcomes were all-cause mortality, re-infarction, and major bleeding. Multivariable logistic regression and propensity score matching were used to adjust for confounding. Subgroup and interaction analyses were also performed.
Results:
The cohort included 12,365 patients with STEMI and 9424 patients with NSTEMI. At baseline, patients with NSTEMI had more comorbidities, cardiovascular risk factors (except diabetes), and prior revascularization. Patients with STEMI were more frequently treated with statins, beta-blockers, and renin-angiotensin-aldosterone system inhibitors at discharge. At 1-year follow-up, overall outcomes were comparable between groups. Nonfatal reinfarction occurred more frequently in patients with NSTEMI (3.4% versus 2.8%, p = 0.022), but this association was not significant after adjustment (odds ratio [OR] 0.90, 95% confidence interval [CI] 0.65-1.24, p = 0.519). Results from propensity score-matched analyses confirmed the absence of prognostic differences. Subgroup analyses revealed significant interactions for diabetes mellitus and completeness of revascularization.
Conclusions:
After accounting for clinical and therapeutic variables, 1-year outcomes were largely similar in patients with STEMI and NSTEMI. Differences in reinfarction risk appear to be driven by baseline characteristics and treatment patterns, rather than infarct type itself.
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