Long-term mortality of patients undergoing cardiac catheterization for ST-elevation and nonst-elevation myocardial infarction

Mark Y. Chan, Jie L. Sun, L. Kristin Newby, Linda K. Shaw, Min Lin, Eric D. Peterson, Robert M. Califf, David F. Kong, Matthew T. Roe

Research output: Contribution to journalArticlepeer-review

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 languageEnglish (US)
Pages (from-to)3110-3117
Number of pages8
JournalCirculation
Volume119
Issue number24
DOIs
StatePublished - Jun 23 2009
Externally publishedYes

Keywords

  • Acute coronary syndrome
  • Angioplasty
  • Catheterization
  • Coronary disease
  • Electrocardiography
  • Myocardial infarction
  • Revascularization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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