A comparison of ST elevation versus non-ST elevation myocardial infarction outcomes in a large registry database: Are non-ST myocardial infarctions associated with worse long-term prognoses?

Polonski, Lech; Gasior, Mariusz; Gierlotka, Marek; Osadnik, Tadeusz; Kalarus, Zbigniew; Trusz-Gluza, Maria; Zembala, Marian; Wilczek, Krzysztof; Lekston, Andrzej; Zdrojewski, Tomasz; Tendera, Michal; on behalf of the PL-ACS Registry Pilot Group,

doi:10.1016/j.ijcard.2010.07.008

« Previous Next »International Journal of Cardiology
Volume 152, Issue 1 , Pages 70-77, 6 October 2011

A comparison of ST elevation versus non-ST elevation myocardial infarction outcomes in a large registry database:

Are non-ST myocardial infarctions associated with worse long-term prognoses?

Lech Polonski
- Silesian Centre for Heart Diseases, IIIrd Department of Cardiology, Medical Faculty in Zabrze, Medical University of Silesia, Poland
Mariusz Gasior
- Silesian Centre for Heart Diseases, IIIrd Department of Cardiology, Medical Faculty in Zabrze, Medical University of Silesia, Poland
Marek Gierlotka
- Silesian Centre for Heart Diseases, IIIrd Department of Cardiology, Medical Faculty in Zabrze, Medical University of Silesia, Poland
Tadeusz Osadnik
- Silesian Centre for Heart Diseases, IIIrd Department of Cardiology, Medical Faculty in Zabrze, Medical University of Silesia, Poland
- Corresponding author. IIIrd Chair and Department of Cardiology, Medical Faculty in Zabrze, Medical University of Silesia, Silesian Centre for Heart Diseases, Szpitalna 2 41-800 Zabrze, Poland. Tel.: +48 32 3733619; fax: +48 32 2732679.
Zbigniew Kalarus
- Silesian Centre for Heart Diseases, Ist Department of Cardiology, Medical Faculty in Zabrze, Medical University of Silesia, Poland
Maria Trusz-Gluza
- Ist Chair and Department of Cardiology, Medical Faculty in Katowice, Medical University of Silesia, Poland
Marian Zembala
- Silesian Centre for Heart Diseases, Chair and Department of Cardiosurgery and Transplantology, Medical Faculty in Zabrze, Medical University of Silesia, Poland
Krzysztof Wilczek
- Silesian Centre for Heart Diseases, IIIrd Department of Cardiology, Medical Faculty in Zabrze, Medical University of Silesia, Poland
Andrzej Lekston
- Silesian Centre for Heart Diseases, IIIrd Department of Cardiology, Medical Faculty in Zabrze, Medical University of Silesia, Poland
Tomasz Zdrojewski
- Department of Diabetology and Hypertension, Medical University of Gdansk, Poland
Michal Tendera
- IIIrd Chair and Department of Cardiology, Medical Faculty in Katowice, Medical University of Silesia, Poland
on behalf of the PL-ACS Registry Pilot Group

Received 1 February 2010; received in revised form 10 June 2010; accepted 2 July 2010. published online 04 August 2010.

Abstract

Background

Prognoses in STEMI and NSTEMI beyond one year from onset remain unclear. We aimed to compare the treatments and the two-year outcomes in patients with myocardial infarction (MI) enrolled at the Polish Registry of Acute Coronary Syndromes (PL-ACS).

Methods

A total of 13,441 patients with MI (8250 with STEMI, and 5191 with NSTEMI) underwent medical care between October 2003 and June 2005 in the Silesia region (4.8 million inhabitants). The events analyzed were death, MI, stroke and percutaneous (PCI) or surgical (CABG) revascularization.

Results

After two years, NSTEMI was associated with a higher incidence of death (hazard ratio (HR) of 1.09 (95% confidence interval (CI) 1.02–1.17, p<0.0001)); a higher incidence of reinfarction, stroke, CABG and a lower rate of PCI. Adjustments for baseline characteristics and treatment strategy (invasive vs. non-invasive) reversed the HR for mortality and eliminated the difference in MI and stroke. The adjusted HR for mortality was 0.76 (95% CI, 0.71–0.83, p<0.0001). STEMI and NSTEMI patients treated non-invasively were older and showed higher incidences of diabetes, obesity, pulmonary edema and cardiogenic shock than their invasively treated counterparts. Invasively treated patients received aspirin, beta-blockers, ACE inhibitors and statins more often during hospitalization and at discharge.

Conclusions

The unadjusted long-term prognosis was worse in NSTEMI. After adjustment for the baseline characteristics and treatment strategy, the long-term prognosis was worse in STEMI. Patients with MI treated invasively showed more favorable clinical characteristics and received guideline-recommended therapy more often than patients who did not undergo invasive treatment.

Keywords: Myocardial infarction, Long-term outcome, Percutaneous transluminal coronary angioplasty