Key result
NSTEMI is linked to ~37% lower 12-month MACE versus STEMI in PCI with reduced TIMI flow.
Why the study?
The clinical implications of reduced preprocedural TIMI flow in patients with NSTEMI have not been fully elucidated compared to STEMI patients undergoing PCI.
Does NSTEMI presentation improve 12-month clinical outcomes in AMI patients with reduced preprocedural TIMI flow undergoing PCI compared to STEMI presentation?
Cohort (n=7,336)
Yes
Does NSTEMI presentation improve 12-month clinical outcomes in AMI patients with reduced preprocedural TIMI flow undergoing PCI compared to STEMI presentation?
Among AMI patients with reduced preprocedural TIMI flow undergoing PCI, those with NSTEMI have significantly better 12-month clinical outcomes compared to those with STEMI.
Answers are grounded in this paper and cite their sources.
Reduced preprocedural TIMI flow implications in NSTEMI remain unclear from registry data; leaves open whether it should guide risk stratification or reperfusion.
BACKGROUND: Reduced preprocedural thrombolysis in myocardial infarction (TIMI) flow in patients with ST-segment elevation myocardial infarction (STEMI) is known to be associated with increased mortality. However, clinical implications of reduced preprocedural TIMI flow in patients with non-ST-segment elevation myocardial infarction (NSTEMI) have not been fully elucidated as yet. The aim of the present study was to compare the clinical influence of reduced preprocedural TIMI flows between patients with STEMI and NSTEMI undergoing percutaneous coronary intervention (PCI). METHODS: From the Korea Acute Myocardial Infarction Registry, a total of 7336 AMI patients with angiographically confirmed reduced preprocedural TIMI flow (TIMI 0/1) during PCI were selected and divided into STEMI (n=4852) and NSTEMI (n=2484) groups. The 12-month composite of total death, nonfatal myocardial infarction, coronary artery bypass graft, and repeated PCI was compared between the two groups. RESULTS: After adjustment of baseline confounders by propensity score stratification, the NSTEMI group had lower incidences of major adverse cardiac events than the STEMI group (7.15 vs. 11.19%; hazard ratio: 0.63; 95% confidence interval: 0.47-0.84; P=0.001) at 12 months, which was largely attributable to the lower incidences of total deaths (2.43 vs. 3.99%; P=0.04) and repeated PCI (3.81 vs. 6.41%; P=0.01). CONCLUSION: Among AMI patients with TIMI 0/1, patients with NSTEMI had better outcomes compared with those of patients with STEMI on the basis of the incidences of 12-month outcomes. This could be attributable to lower total death and repeated revascularization in patients with NSTEMI.
No takes yet. Share an insight, caveat, or question.
Baek et al. (2018) conducted a cohort in Acute Myocardial Infarction with reduced preprocedural TIMI flow (n=7,336). Non-ST-segment elevation myocardial infarction (NSTEMI) vs. ST-segment elevation myocardial infarction (STEMI) was evaluated on 12-month composite of total death, nonfatal myocardial infarction, coronary artery bypass graft, and repeated PCI (major adverse cardiac events) (HR 0.63, 95% CI 0.47-0.84, p=0.001). Among AMI patients with reduced preprocedural TIMI flow undergoing PCI, NSTEMI was associated with a lower 12-month incidence of major adverse cardiac events compared to STEMI (HR 0.63; 95% CI 0.47-0.84; P=0.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: