Key result
Patients undergoing PCI for NSTEMI had significantly worse long-term cardiac mortality compared to those with stable angina (HR 2.31), whereas outcomes for STEMI patients were similar to stable angina.
Why the study?
Does percutaneous coronary intervention for NSTEMI or STEMI result in different long-term cardiac mortality and MACE compared to PCI for stable angina?
Cohort (n=1,909)
Yes
Does percutaneous coronary intervention for NSTEMI or STEMI result in different long-term cardiac mortality and MACE compared to PCI for stable angina?
Hazard Ratio: 2.31 (95% CI 1.1–4.87)
Absolute Event Rate: 3.95% vs 1.13%
p-value: p=0.028
In an all-comers PCI registry, patients presenting with NSTEMI had significantly worse long-term cardiac mortality compared to those with stable angina, whereas STEMI patients had similar outcomes to stable angina patients.
BACKGROUND: Contemporary data remains limited regarding mortality and major adverse cardiac events (MACE) outcomes in patients undergoing PCI for different manifestations of coronary artery disease. OBJECTIVES: We evaluated mortality and MACE outcomes in patients treated with PCI for STEMI (ST-elevation myocardial infarction), NSTEMI (non ST-elevation myocardial infarction) and stable angina through analysis of data derived from the Nobori-2 study. METHODS: Clinical endpoints were cardiac mortality and MACE (a composite of cardiac death, myocardial infarction and target vessel revascularization). RESULTS: 1909 patients who underwent PCI were studied; 1332 with stable angina, 248 with STEMI and 329 with NSTEMI. Age-adjusted Charlson co-morbidity index was greatest in the NSTEMI cohort (3.78±1.91) and lowest in the stable angina cohort (3.00±1.69); P<0.0001. Following Cox multivariate analysis cardiac mortality was independently worse in the NSTEMI vs the stable angina cohort (HR 2.31 (1.10-4.87), p = 0.028) but not significantly different for STEMI vs stable angina cohort (HR 0.72 (0.16-3.19), p = 0.67). Similar observations were recorded for MACE (<180 days) (NSTEMI vs stable angina: HR 2.34 (1.21-4.55), p = 0.012; STEMI vs stable angina: HR 2.19 (0.97-4.98), p = 0.061. CONCLUSIONS: The longer-term Cardiac mortality and MACE were significantly worse for patients following PCI for NSTEMI even after adjustment of clinical demographics and Charlson co-morbidity index whilst the longer-term prognosis of patients following PCI STEMI was favorable, with similar outcomes as those patients with stable angina following PCI.
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Fath‐Ordoubadi et al. (2014) conducted a cohort in Acute and Stable Coronary Syndromes (n=1,909). NSTEMI vs. Stable angina was evaluated on Cardiac mortality (HR 2.31, 95% CI 1.10-4.87, p=0.028). Patients undergoing PCI for NSTEMI had significantly worse long-term cardiac mortality compared to those with stable angina (HR 2.31), whereas outcomes for STEMI patients were similar to stable angina.
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