Key result
NSTEMI linked to an ~11% rate of hemodynamic instability, significantly higher than STEMI.
Why the study?
Emerging data suggest NSTEMI may carry a greater burden of comorbidities and anatomical complexity compared to STEMI, despite STEMI typically being associated with more extensive infarcts.
Do patients with NSTEMI have different rates of ventricular arrhythmias, hemodynamic instability, and culprit lesion distributions compared to patients with STEMI?
Cohort (n=172)
No
Do patients with NSTEMI have different rates of ventricular arrhythmias, hemodynamic instability, and culprit lesion distributions compared to patients with STEMI?
Absolute Event Rate: 10.93% vs 0.18%
p-value: p=0.005
Patients with NSTEMI may present with higher rates of hemodynamic instability and more complex coronary anatomy (such as left main disease) compared to STEMI patients, highlighting the need for vigilant monitoring.
Background Acute coronary syndrome (ACS) includes ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI), each with distinct clinical profiles and outcomes. While STEMI is typically associated with more extensive infarcts, emerging data suggest NSTEMI may carry a greater burden of comorbidities and anatomical complexity. Objective To compare the incidence of ventricular arrhythmias and hemodynamic instability in patients with STEMI vs. NSTEMI and to analyze the distribution of culprit coronary lesions. Methods: This retrospective single-center study included 172 patients who underwent coronary revascularization between April and July 2021. Clinical outcomes, arrhythmias, and hemodynamic instability were compared between groups with STEMI (n = 108) and NSTEMI (n = 64). Culprit lesions were evaluated by angiography and categorized by vessel. Results Hemodynamic instability was significantly more common in patients with NSTEMI (10.93%) compared to STEMI (0.18%) (p = 0.005). Ventricular arrhythmias occurred in 12.03% of patients with STEMI and 7.81% of patients with NSTEMI, with no significant difference. Left main coronary artery lesions were notably more frequent in NSTEMI (47.4% vs. 2.04%; p < 0.0001), whereas right coronary artery involvement was higher in STEMI (40.81% vs. 7.4%; p < 0.0001). Ventricular arrhythmias were significantly associated with circumflex artery lesions in patients with NSTEMI (p = 0.0001). Conclusions Despite often being perceived as lower risk, patients with NSTEMI exhibited a higher rate of hemodynamic instability and more complex coronary involvement, particularly left main disease. These findings highlight the need for vigilant monitoring and individualized treatment strategies in populations with NSTEMI.
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Păsăroiu et al. (2026) conducted a cohort in Acute coronary syndrome (n=172). NSTEMI vs. STEMI was evaluated on Hemodynamic instability (p=0.005). Patients with NSTEMI exhibited a significantly higher rate of hemodynamic instability compared to those with STEMI (10.93% vs. 0.18%, p=0.005).
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