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Invasive versus non-invasive management in non-ST segment elevation myocardial infarction patients with pulmonary

Ze Zhang1, Tianshu Gu1, Haonan Xu1

  • 1Cardiology Department, The Second Hospital of Tianjin Medical University, Tianjin, China.

SAGE Open Medicine
|June 26, 2026
PubMed

Insights

Invasive management for non-ST-segment elevation myocardial infarction (NSTEMI) with pulmonary hypertension (PH) reduced major adverse cardiovascular events but increased bleeding risk. Individualized treatment is crucial for these high-risk patients.

Area of Science:

  • Cardiology
  • Pulmonology
  • Clinical Research

Background:

  • Non-ST-segment elevation myocardial infarction (NSTEMI) is a common acute coronary syndrome with significant morbidity and mortality.
  • Pulmonary hypertension (PH) complicates NSTEMI management and is linked to adverse cardiovascular outcomes.
  • Optimal treatment strategies for NSTEMI patients with PH are not well-established.

Purpose of the Study:

  • To evaluate the association between invasive versus conservative management and short- and long-term outcomes in NSTEMI patients with PH.
  • To assess the impact of different treatment strategies on major adverse cardiovascular events (MACE) and bleeding risk.

Main Methods:

  • Retrospective multicenter cohort study using real-world data from January 2010 to March 2023.
  • Included 985 adult patients with NSTEMI and concomitant PH.
  • Analyzed outcomes based on invasive versus conservative management using propensity score weighting and doubly robust Cox regression models.

Main Results:

  • Invasive management (24.7%) was associated with a significantly lower risk of 1-year MACE (aHR 0.60) and cardiac death (aHR 0.54) compared to conservative treatment (75.3%).
  • However, the invasive group experienced a higher risk of bleeding (aHR 2.86).

Conclusions:

  • Invasive management in NSTEMI patients with PH reduces ischemic events but increases bleeding complications.
  • Individualized treatment strategies are necessary to balance the benefits and risks for these patients.
Abstract

Keywords:
invasive managementnon-ST segment elevation myocardial infarctionprognosispulmonary hypertension

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