Korean Circ J.  2007 Nov;37(11):550-558. 10.4070/kcj.2007.37.11.550.

In-Hospital Outcome According to the Initial Management and the "Thrombolysis in Myocardial Infarction Risk Score" of Acute Non-ST Segment Elevation Myocardial Infarction

• Jeong HC
• Jeong MH
• Ahn YK
• Chae SC
• Kim YJ
• Hur SH
• Choi DH
• Yoon JH
• Chae JK
• Kim DI
• Koo BK
• Hwang JY
• Oh SK
• Kim KS
• Jeong KT
• Kim CJ
• Chung WS
• Jang YS
• other Korea Acute Myocardial Infarction Registry Investigators

• KMID: 1909616
• DOI: http://doi.org/10.4070/kcj.2007.37.11.550

Abstract

BACKGROUND AND OBJECTIVES: The current guidelines recommend an early invasive strategy for patients suffering with non-ST segment elevation myocardial infarction (NSTEMI). However, there is still debate about the timing of revascularization in patients with NSTEMI. To analyze the clinical efficacy of the timing of revascularization, we compared the in-hospital clinical outcome of NSTEMI patients from the Korea Acute Myocardial Infarction Registry (KAMIR) between the early and selective invasive therapeutic groups.
SUBJECTS AND METHODS
Between Nov. 2005 and Apr. 2007, 2762 acute NSTEMI patients (mean age=64.6+/-12.8 years, 1847 males) were enrolled in the KAMIR. The therapeutic strategy of NSTEMI was categorized into early invasive treatment (within 48 hours, Group I mean age: 63.1+/-13.1 years, 1085 males) and selective invasive treatment (Group II mean age: 66.5+/-12.1 years, 762 males). The initial clinical status and the in-hospital mortality and morbidity rate were compared between these two groups. The in-hospital outcomes were also compared between the two groups according to each level of the Thrombolysis In Myocardial Infarction (TIMI) risk score.
RESULTS
There were significant differences in the mortality and morbidity rate between the groups (6.5% vs. 10.3%, respectively, p<0.001). According to TIMI risk score, there were no significant differences of mortality and morbidity for the low to moderate risk patients (5.3% vs. 7.8%, respectively, p=0.123 for the risk score 0-2, 6.4% vs. 8.7%, p=0.139 for the risk score 3-4).
CONCLUSION
Early invasive treatment improves the hospital outcome for the high-risk NSTEMI patients. The use of abciximab, a low ejection fraction, a high Killip class, a high TIMI risk score and old age are the predictive factors of in-hospital mortality and morbidity.

Keyword

Myocardial infarction; Angioplasty; Thrombolytic therapy; Prognosis

MeSH Terms

Angioplasty
Hospital Mortality
Humans
Korea
Mortality
Myocardial Infarction*
Prognosis
Thrombolytic Therapy

Figure

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  Fig. 1 Primary outcome according to the TIMI risk score. TIMI: thrombolysis in myocardial infarction.

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  Fig. 2 Estimated rates and relative risk of the composite primary end points of the in hospital mortality and morbidity according to the subgroups.

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