Abstract
BACKGROUND: There are limited contemporary data comparing long-term outcomes after cardiac catheterization for ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). METHODS AND RESULTS: We studied patients undergoing cardiac catheterization for STEMI (n≤2413) and NSTEMI (n≤1974) between 1999 and 2005 with at least 1 significant coronary lesion ĝ‰¥75%. We compared adjusted mortality rates over restricted time intervals and the differential impact of early revascularization on mortality stratified by ST-elevation status. Between 1999 and 2007, 1274 patients died, with a median follow-up of 4 years. A piece-wise analysis showed a higher adjusted mortality risk for STEMI during the first 2 months (adjusted hazard ratio, 1.85; 95% confidence interval, 1.45 to 2.38) and a lower adjusted mortality risk for STEMI after 2 months (adjusted hazard ratio, 0.68; 95% confidence interval, 0.59 to 0.83). Compared with late or no revascularization, early revascularization was associated with a lower adjusted risk of mortality for both STEMI (adjusted hazard ratio, 0.73; 95% confidence interval, 0.58 to 0.90) and NSTEMI (adjusted hazard ratio, 0.76; 95% confidence interval, 0.65 to 0.89) (P for interaction≤0.22). CONCLUSIONS: Among a contemporary cohort of acute MI patients with significant coronary disease during cardiac catheterization, STEMI was associated with a higher risk of short-term mortality, but NSTEMI was associated with a higher risk of long-term mortality. Early revascularization was associated with a similar improvement in long-term outcomes for both STEMI and NSTEMI. These data suggest that in clinical investigations of early revascularization among patients with NSTEMI, extended follow-up may be necessary to demonstrate treatment benefit.
Original language | English (US) |
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Pages (from-to) | 3110-3117 |
Number of pages | 8 |
Journal | Circulation |
Volume | 119 |
Issue number | 24 |
DOIs | |
State | Published - Jun 23 2009 |
Externally published | Yes |
Keywords
- Acute coronary syndrome
- Angioplasty
- Catheterization
- Coronary disease
- Electrocardiography
- Myocardial infarction
- Revascularization
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Physiology (medical)