Differences in Short- and Long-Term Outcomes Among Older Patients With ST-Elevation Versus Non–ST-Elevation Myocardial Infarction With Angiographically Proven Coronary Artery Disease

Abstract

O utcomes among patients presenting with ST-segmentelevation myocardial infarction (STEMI) and non-STsegment-elevation myocardial infarction (NSTEMI) have improved markedly because of a combination of rapid recognition of the myocardial infarction (MI) event, early invasive management with revascularization, and aggressive secondary prevention treatment strategies. Previous studies have demonstrated differential short-and long-term mortality risks by MI classification (STEMI versus NSTEMI).1-4 Although patients presenting with STEMI have been demonstrated to have a higher risk of early mortality, 4 patients presenting with NSTEMI have been shown to have a higher risk of long-term mortality that has been attributed to the higher burden of comorbidities and a greater prevalence of multivessel coronary disease in these patients. 1Notwithstanding these findings, most studies that observed differential risks of long-term outcomes between STEMI and NSTEMI patients included younger populations of patients Background-Among older patients with acute myocardial infarction (MI), it remains uncertain whether there is a timedependent difference in the risk of recurrent mortality and nonfatal cardiovascular and cerebrovascular events for those with ST-segment-elevation MI (STEMI) compared with those with non-ST-segment-elevation MI. Methods and Results-Older patients ≥65 years with acute MI and significant coronary artery disease identified with coronary angiography from the ACTION Registry-GWTG (Get With the Guidelines) were linked to Medicare claims data from 2007 to 2010. We examined the unadjusted cumulative incidence of each outcome studied from hospital discharge through 2 years with log-rank tests and then performed a piece-wise proportional hazards modeling with 2 time periods: discharge to 90 days and 90 days to 2 years. Among the 46 199 patients linked with Medicare data, 17 287 (37.4%) presented with STEMI. Through 2 years, the unadjusted cumulative incidence of all-cause mortality (16.0% versus 19.8%; P<0.001) and the composite outcome (21.9% versus 27.9%; P<0.001) was lower for STEMI patients. Within the first 90 days, unadjusted rates of mortality (5.5% versus 5.3%) and the composite outcome (7.9% versus 8.1%) were similar but diverged from 90 days to 2 years (mortality, 11.1% versus 15.4%; P<0.001; composite outcome, 15.2% versus 21.5%; P<0.001). After multivariable adjustment, the adjusted risks of mortality and the composite outcome through 90 days were higher for STEMI patients, whereas risks of mortality and the composite outcome were attenuated from 90 days through 2 years. Conclusions-Among older acute MI patients with angiographically confirmed coronary artery disease discharged alive, STEMI patients (compared with non-ST-segment-elevation MI patients) were found to have a lower frequency of unadjusted postdischarge mortality and composite cardiovascular and cerebrovascular outcomes through 2 years after hospital discharge. This analysis provides unique insight into differential short-and long-term risks...

The Outcome of Patients with Acute Coronary Syndrome Those Associated with Impaired Glucose Tolerance in AL-Nasiriya Governorate / Iraq

“…Figure 6 show 42% of patients with NSTEMI (non ST-Segment elevation myocardial infarction and unstable angina) and 28% of patients with STEMI were ended with early percutaneous coronary angiography (PCI) in the cardiac center. This result is differ from other study which revealed that the PCI was more common in STEMI patients compared with NSTEMI patients who had either coronary artery bypass grafting or medical management [44]. Figure 7 show that 11 patients with ACS those found to be have impaired glucose tolerance (IGT) were died during the first week of presentation in comparison with 2 patients with normal sugar state were died in that period of presentation with highly statistically significant value (P value<0.0001) which similar to a study, Prashanth Panduranga.…”

Invasive and antiplatelet treatment of patients with non‐ST‐segment elevation myocardial infarction: Understanding and addressing the global risk‐treatment paradox

“…[1][2][3][4] Although both patients with NSTEMI and ST-segment elevation myocardial infarction (STEMI) are at a high risk of recurrent cardiovascular events, patients with NSTEMI have higher long-term mortality and cardiovascular risk than those with STEMI. [5][6][7][8] Furthermore, the proportion of patients with acute myocardial infarction (MI) who have NSTEMI is increasing relative to those with STEMI. [9][10][11] Results from the French Registry of Acute ST-Elevation or Non-ST-Elevation Myocardial Infarction (FAST-MI) and the Swedish Websystem for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) registry showed that the 6-month and 1-year mortality of patients with STEMI or NSTEMI have generally decreased since 1995.…”

“…Despite the above recommendations and findings, patients with NSTEMI often receive less aggressive secondary prevention treatment than patients with STEMI. 8,28 Moreover, patients who have the highest ischemic risk often receive the least aggressive treatment, including both invasive and medical management; a phenomenon that has been termed the "treatment-risk paradox." [29][30][31][32] Suboptimal treatment of patients with multiple ischemic risk factors was highlighted in the Pattern of Repeat Cardiovascular Events…”

“…Non‐ST‐segment elevation myocardial infarction (NSTEMI) is the leading cause of emergency hospitalization for acute coronary syndrome (ACS) in Europe and North America . Although both patients with NSTEMI and ST‐segment elevation myocardial infarction (STEMI) are at a high risk of recurrent cardiovascular events, patients with NSTEMI have higher long‐term mortality and cardiovascular risk than those with STEMI . Furthermore, the proportion of patients with acute myocardial infarction (MI) who have NSTEMI is increasing relative to those with STEMI …”

Transition of care to prevent recurrence after acute coronary syndrome: the critical role of the primary care provider and pharmacist

“…MI prevalence is almost twice as high for men than for women (4% vs 2.3%) in the United States, with the average age at initial MI slightly higher in women than in men (72.0 years vs 65.6 years) [3]. Patients with NSTEMI are generally older with a higher burden of disease and comorbidities, a level of clinical complexity necessitating effective transition of care management [8]. Reports indicate that two-thirds of MI are NSTEMI [9] with the risk of recurrent CV events being higher in patients with NSTEMI than in those with STEMI [8].…”