Key result
NSTEMI was not associated with a significantly different adjusted risk of all-cause mortality compared to STEMI within 6 months (HR 0.83) or beyond 6 months (HR 1.04) after acute myocardial infarction.
Why the study?
Detailed causes of death in NSTEMI have not been adequately evaluated compared to those in STEMI.
Does NSTEMI compared to STEMI affect all-cause death in AMI patients undergoing PCI?
Cohort (n=6,228)
Yes
Does NSTEMI compared to STEMI affect all-cause death in AMI patients undergoing PCI?
After adjusting for confounders, the short- and long-term mortality risks were not significantly different between STEMI and NSTEMI patients undergoing PCI, though causes of death varied in the early phase.
Similar post-PCI mortality risks in NSTEMI and STEMI should not yet change practice; leaves open cause-specific differences and targeted strategies.
BACKGROUND: The detailed causes of death in non-ST-segment-elevation myocardial infarction (NSTEMI) have not been adequately evaluated compared to those in ST-segment elevation myocardial infarction (STEMI). METHODS: The study population was 6,228 AMI patients who underwent percutaneous coronary intervention (STEMI: 4,625 patients and NSTEMI: 1,603 patients). The primary outcome was all-cause death. RESULTS: Within 6 months after AMI, the adjusted mortality risk was not significantly different between NSTEMI patients and STEMI patients (HR: 0.83, 95%CI: 0.67-1.03, P = 0.09). Regarding the causes of death within 6 months after AMI, mechanical complications more frequently occurred in STEMI patients than in NSTEMI patients, while proportions of post resuscitation status on arrival and heart failure were higher in in NSTEMI patients than in STEMI patients. Beyond 6 months after AMI, the adjusted mortality risk of NSTEMI relative to STEMI was not significantly different. (HR: 1.04, 95%CI: 0.90-1.20, P = 0.59). Regarding causes of death beyond 6 months after AMI, almost half of deaths were cardiovascular causes in both groups, and breakdown of causes of death was similar between NSTEMI and STEMI. CONCLUSION: The mortality risk within and beyond 6 months after AMI were not significantly different between STEMI patients and NSTEMI patients after adjusting confounders. Deaths due to post resuscitation status and heart failure were more frequent in NSTEMI within 6 months after AMI.
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Takeji et al. (2021) conducted a cohort in Acute myocardial infarction (n=6,228). NSTEMI vs. STEMI was evaluated on All-cause death within 6 months (HR 0.83, 95% CI 0.67-1.03, p=0.09). NSTEMI was not associated with a significantly different adjusted risk of all-cause mortality compared to STEMI within 6 months (HR 0.83) or beyond 6 months (HR 1.04) after acute myocardial infarction.
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