Long-term prognosis of patients with non-ST-segment elevation myocardial infarction according to coronary arteries atherosclerosis extent on coronary angiography: a historical cohort study

Abstract

BackgroundPatients with non-ST-segment elevation myocardial infarction (NSTEMI) without obstructive coronary artery disease (CAD) are often managed differently than those with obstructive CAD, therefore we aimed in this study to examine the long-term prognosis of patients with NSTEMI according to the degree of CAD on coronary angiography (CAG).MethodsWe examined 8.889 consecutive patients admitted for first time NSTEMI during 2000–2011, to whom CAG was performed. Patients were classified by CAG into: 0-vessel disease (0VD), diffuse atherosclerosis (DA) (0% < stenosis <50%), 1-vessel disease (1VD), 2VD, and 3VD with stenosis ≥50%. Follow-up period: 13 years (median 4.5).ResultsOne-year mortality for NSTEMI patients with 0VD was 3.7%, DA 5.7%, 1VD 2.5%, 2VD 4.8%, and 3VD 11.5%. Non-diabetic 0VD patients had higher risk of mortality than 1VD patients (HR:1.59; 95% CI:1.21–2.02; P < 0.001), while those with diabetes mellitus (DM) had not significantly different risk. In addition 0VD group had higher risk of heart failure (HF) (HR 1.61; 95% CI: 1.39–1.88; P < 0.001), and lower risk of recurrent MI (HR:0.55; 95% CI:0.39–0.77; P < 0.001) compared with 1VD. For patients with DA; mortality and HF risks were higher than 1VD and not different than 2VD, while recurrent MI risk was not different than 1VD and lower than 2VD.Finally, the DA group had higher risk of mortality if they had DM, higher risk of recurrent MI, and not different risk of HF and stroke compared with the 0VD group patients.ConclusionPatients with NSTEMI and non-obstructive CAD (both normal coronaries and diffuse atherosclerosis) have a comparable prognosis to patients with one- or two-vessel disease. Patients with diffuse atherosclerosis have worse prognosis than those with angiographically normal coronary arteries.Electronic supplementary materialThe online version of this article (10.1186/s12872-017-0710-3) contains supplementary material, which is available to authorized users.

Ischemia and No Obstructive Coronary Artery Disease (INOCA): What Is the Risk?

“…The observed elevated MACE rate endorses this as a knowledge gap. Even mild degrees of atherosclerosis or abnormal coronary vasoreactivity are related to increased health risk 4, 26, 83, 84. Furthermore, the majority of MIs result from rupture of nonobstructive plaque, highlighting the importance of optimizing therapy in these patients 85, 86.…”

Association of St Elevation in Lead Avr With Left Main Stem and Triple Vessel Diseases in Patients With Non-St Elevation Myocardial Infarction

“…The patients with Non-ST elevation myocardial infarction (NSTEMI) have variable degree of severity of coronary artery disease and prognosis. 1 The electrocardiogram (ECG) at first medical contact and at the time of admission has a crucial contribution in easy and an early risk stratification. 1,2 Previous studies have proved that patients with even ST depression of >0.5 mm on the admission ECG may need early invasive management strategy.…”

“…1 The electrocardiogram (ECG) at first medical contact and at the time of admission has a crucial contribution in easy and an early risk stratification. 1,2 Previous studies have proved that patients with even ST depression of >0.5 mm on the admission ECG may need early invasive management strategy. 2 Different risk scoring methods like TIMI scoring system for NSTEMI have also used ST deviation as an independent predictor of adverse outcome.…”

Reproducing extracellular matrix adverse remodelling of non-ST myocardial infarction in a large animal model

“…NSTEMI patients have lower in-patient (during their admission for the primary NSTEMI) and short-term mortality rates, but significantly higher long-term mortality than those of STEMI patients [6][7][8] . A Danish registry study of 8,889 patients showed that the 5-year mortality after NSTEMI was 16% 51 , and another registry study highlighted a 10-year survival rate of only around 50% 9 . Nonetheless, to the best of our knowledge, there are currently no large animal models that can reproduce both the functional and histological characteristics of NSTEMIs as a preclinical foundation to study interventions that might ameliorate short and long-term effects of NSTEMI.…”