Comparison of the prognosis of patients with acute ST-elevation and non-ST-elevation myocardial infarction

Kim, Min Chul; Ahn, Youngkeun; Cho, Kyung Hun; Park, Dong Jin; Kim, Hyun Kuk; Kim, Sung Soo; Jeong, Hae Chang; Cho, Jae Young; Park, Keun Ho; Sim, Doo Sun; Yoon, Nam Sik; Yoon, Hyun Ju; Kim, Kye Hun; Hong, Young Joon; Park, Hyung Wook; Kim, Ju Han; Jeong, Myung Ho; Cho, Jeong Gwan; Park, Jong Chun; Kang, Jung Chaee

Abstract

BACKGROUND/AIMS
Acute ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) have different therapeutic strategies. This study assessed the risk factors, therapeutic strategies, clinical outcomes, and prognostic factors of STEMI and NSTEMI.
METHODS
Patients admitted to our hospital with a diagnosis of acute myocardial infarction between November 2005 and December 2006 were evaluated. We analyzed their baseline clinical characteristics, angiographic characteristics, in-hospital mortality, and major adverse cardiac events (MACE) during clinical follow-up for 1 year in patients with STEMI and NSTEMI.
RESULTS
There were 447 STEMI patients and 186 NSTEMI patients. Smoking was the most common risk factor in both groups. In the STEMI group, primary percutaneous coronary intervention was performed in 85.0% and thrombolysis was performed in 7.2% of the patients. In the NSTEMI group, an early invasive strategy was chosen in 66.7% of the patients. The in-hospital mortality rate was 3.8% in the STEMI group and 3.2% in the NSTEMI group. The rates of MACE at 6 months and 1 year did not differ significantly between the groups (17.7% vs. 17.3% and 22.8% vs. 20.2%, respectively). Independent predictors of prognosis were diabetes mellitus, smoking, and left ventricular ejection fraction (LVEF)<40% on admission in the NSTEMI group, and serum troponin I in the STEMI group. Troponin I was the only predictor of prognosis in the STEMI group (p=0.047 vs. p=0.139).
CONCLUSIONS
Patients with STEMI and NSTEMI had similar clinical outcomes during a 1-year clinical follow-up. Of the predictors of prognosis, troponin I is the only one in STEMI.