Occluded culprit arteries in NSTEMI patients were associated with a higher 48-month risk of cardiac death, recurrent MI, and TVR (27.5% vs 17.9%; HR 1.689; 95% CI 1.385-2.059; P<0.001).
Cohort (n=2,878)
Yes
Do occluded culprit arteries increase the risk of adverse cardiovascular events in patients with NSTEMI?
In patients with NSTEMI, an occluded culprit artery is an independent predictor of long-term adverse cardiovascular events, including cardiac death, recurrent MI, and target vessel revascularization.
Effect estimate: HR 1.689 (95% CI 1.385-2.059)
Absolute Event Rate: 27.5% vs 17.9%
p-value: p=<0.001
BACKGROUND: The prognostic impact of occluded culprit arteries in non-ST-elevation myocardial infarction (NSTEMI) patients beyond 12 months has not been investigated. OBJECTIVES: The impact of occluded culprit arteries on a composite of cardiac death (CD), recurrent nonfatal MI (RMI), and target vessel revascularization (TVR) in patients who presented with NSTEMI was investigated during a 48-month follow-up using propensity-score (PS) matching. METHODS: A total of 2,878 NSTEMI patients in the COREA-AMI (COnvergent REgistry of cAtholic and chonnAm university for Acute MI) Registry were classified according to the angiographic flow of culprit arteries (occlusion OC, n = 1,070; nonocclusion, n = 1,808). After PS matching, the incidence of the primary end-point, a composite of CD, RMI, and TVR was compared. RESULTS: The median follow-up duration was 47.3 months (IQR 32.7-66.2). In the PS-matched population, the 48-month cumulative rates of the primary end-point (27.5% vs. 17.9%, P < 0.001) and each event were higher in the OC group (CD: 9.0% vs. 5.4%, RMI: 16.3% vs. 9.4%, TVR: 10.5% vs. 5.6%, respectively, P < 0.05). In multivariate Cox regression analysis, occluded culprit arteries showed the significant statistical impact on the primary end-point (HR 1.689 1.385-2.059, P < 0.001) and each event (CD: 1.736 1.218-2.475, RMI: 1.918 1.468-2.505, TVR: 2.042 1.453-2.869, respectively, P < 0.05). Furthermore, in the 12-month landmark analysis, occluded culprit arteries were still associated with higher risk of primary end-point beyond 12 months (P < 0.001). CONCLUSIONS: Occluded culprit arteries were independently associated with the higher risk of CD, RMI, and TVR in NSTEMI patients during the 48-month follow-up.
Shin et al. (Wed,) conducted a cohort in Non-ST-elevation myocardial infarction (NSTEMI) (n=2,878). Occluded culprit arteries vs. Nonoccluded culprit arteries was evaluated on Composite of cardiac death (CD), recurrent nonfatal MI (RMI), and target vessel revascularization (TVR) (HR 1.689, 95% CI 1.385-2.059, p=<0.001). Occluded culprit arteries in NSTEMI patients were associated with a higher 48-month risk of cardiac death, recurrent MI, and TVR (27.5% vs 17.9%; HR 1.689; 95% CI 1.385-2.059; P<0.001).