NSTEMI patients with clinical and ECG criteria had a 48% higher adjusted risk of MACE (HR 1.48; 95% CI 1.03-2.14), but diagnostic criteria alone poorly predicted mortality.
Do specific combinations of the Fourth UDMI diagnostic criteria predict mortality and MACE in patients with NSTEMI?
Risk stratification based solely on the diagnostic criteria of the Fourth UDMI is insufficient to predict adverse outcomes in NSTEMI patients, as clinical outcomes appear more influenced by baseline characteristics.
Absolute Event Rate: 0% vs 0%
Abstract Background The Fourth Universal Definition of Myocardial Infarction (UDMI) defines acute myocardial infarction (AMI) as an acute myocardial injury associated with clinical evidence of myocardial ischemia. While several studies have evaluated the prognostic stratification of patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI), data regarding the prognostic value of each diagnostic criteria and the potential combinations are poorly investigated. Purpose To evaluate the prognostic role of the diagnostic criteria of the Fourth UDMI, both alone and in combination, in NSTEMI patients. Methods We enrolled all consecutive patients hospitalized for NSTEMI who underwent coronary angiography (CAG) within 72 hours from admission at our hospitals. Patients with very high-risk NSTEMI, with a history of AMI or contraindications to CAG were excluded from the study. Patients were then divided into three subgroups according to the combination of diagnostic criteria presented at admission. The primary endpoint of the study was 2-years all-cause mortality and the secondary endpoint was a composite of all-cause mortality, non- fatal reinfarction, unplanned revascularization, non-fatal ischemic stroke, and hospitalization for heart failure (major adverse cardiovascular events, MACE). Outcomes were compared using the log-rank test and graphically visualized with Kaplan-Meier curves. Logistic regression analyses were performed to identify independent predictors of mortality and major adverse events was performed. The association between the left ventricular ejection fraction and the incident rates of events was evaluated with Poisson regression models. Results The study included 1258 NSTEMI patients divided into three subgroups: 354 (28%) patients fulfilling only clinical criteria (group A), 254 (20%) with clinical and ECG-graphic criteria (group B) and 650 (52%) patients with clinical, ECG-graphic and echo-graphic criteria (group C). Patients in the three subgroups exhibited similar cardiovascular risk factors and comorbidities but differed in clinical and laboratory characteristics at admission. At 24- months follow-up, patients in Group C had higher incident rates of all-cause death and MACE compared to the other subgroups. However, after multivariable adjustment, no statistically significant differences in the mortality risk were found between groups. Patients with clinical and ECG-graphic criteria (group B) had a higher risk of MACE (adjusted HR 1.48; 95% CI 1.03-2.14; p=0.036). Conclusions Risk stratification based on the diagnostic criteria of the Fourth UDMI alone is insufficient to predict adverse outcomes in NSTEMI patients. Clinical outcomes seem to be more influenced by patients’ baseline characteristics, suggesting the need for further research to refine NSTEMI risk models.K-M All-Cause Mortality K-M MACE
Marinelli et al. (Sat,) reported a other. NSTEMI patients with clinical and ECG criteria had a 48% higher adjusted risk of MACE (HR 1.48; 95% CI 1.03-2.14), but diagnostic criteria alone poorly predicted mortality.