Masaharu Ishihara1, Koichi Nakao2, Yukio Ozaki3, Kazuo Kimura4, Junya Ako5, Teruo Noguchi6, Masashi Fujino6, Satoshi Yasuda6, Satoru Suwa7, Kazuteru Fujimoto8, Yasuharu Nakama9, Takashi Morita10, Wataru Shimizu11, Yoshihiko Saito12, Atsushi Hirohata13, Yasuhiro Morita14, Teruo Inoue15, Atsunori Okamura16, Masaaki Uematsu17, Kazuhito Hirata18, Kengo Tanabe19, Yoshisato Shibata20, Mafumi Owa21, Kenichi Tsujita22, Hiroshi Funayama23, Nobuaki Kokubu24, Ken Kozuma25, Tetsuya Tobaru26, Shigeru Oshima27, Michikazu Nakai28, Kunihiro Nishimura29, Yoshihiro Miyamoto29, Hisao Ogawa30. 1. Division of Coronary Artery Disease, Hyogo College of Medicine. 2. Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center. 3. Department of Cardiology, Fujita Health University. 4. Division of Cardiology, Yokohama City University Medical Center. 5. Department of Cardiovascular Medicine, Kitasato University Hospital. 6. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center. 7. Department of Cardiology, Juntendo University Shizuoka Hospital. 8. Department of Cardiology, National Hospital Organization Kumamoto Medical Center. 9. Department of Cardiology, Hiroshima City Hospital. 10. Division of Cardiology, Osaka General Medical Center. 11. Department of Cardiovascular Medicine, Nippon Medical School Hospital. 12. First Department of Internal Medicine, Nara Medical University. 13. Department of Cardiology, The Sakakibara Heart Institute of Okayama. 14. Department of Cardiology, Ogaki Municipal Hospital. 15. Department of Cardiovascular Medicine, Dokkyo Medical University. 16. Department of Cardiology, Sakurabashi Watanabe Hospital. 17. Cardiovascular Center, Kansai Rosai Hospital. 18. Department of Cardiology, Okinawa Chubu Hospital. 19. Division of Cardiology, Mitsui Memorial Hospital. 20. Department of Cardiology, Miyazaki Medical Association Hospital. 21. Department of Cardiovascular Medicine, Suwa Red Cross Hospital. 22. Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University. 23. Department of Integrated Medicine, Saitama Medical Center Jichi Medical University. 24. Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University. 25. Department of Cardiology, Teikyo University. 26. Department of Cardiology, Sakakibara Heart Institute. 27. Department of Cardiology, Gunma Prefectural Cardiovascular Center. 28. Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center. 29. Department of Preventive Cardiology, National Cerebral and Cardiovascular Center. 30. National Cerebral and Cardiovascular Center.
Abstract
BACKGROUND: According to troponin-based criteria of myocardial infarction (MI), patients without elevation of creatine kinase (CK), formerly classified as unstable angina (UA), are now diagnosed as non-ST-elevation MI (NSTEMI), but little is known about their outcomes.Methods and Results: Between July 2012 and March 2014, 3,283 consecutive patients with MI were enrolled. Clinical follow-up data were obtained up to 3 years. The primary endpoint was a composite of all-cause death, non-fatal MI, non-fatal stroke, cardiac failure and urgent revascularization for UA. There were 2,262 patients with ST-elevation MI (STEMI), 563 NSTEMI with CK elevation (NSTEMI+CK) and 458 NSTEMI without CK elevation (NSTEMI-CK). From day 0, Kaplan-Meier curves for the primary endpoint began to diverge in favor of NSTEMI-CK for up to 30 days. The 30-day event rate was significantly lower in patients with NSTEMI-CK (3.3%) than in STEMI (8.6%, P<0.001) and NSTEMI+CK (9.9%, P<0.001). Later, the event curves diverged in favor of STEMI. The event rate from 31 days to 3 years was significantly lower in patients with STEMI (19.8%) than in NSTEMI+CK (33.6%, P<0.001) and NSTEMI-CK (34.2%, P<0.001). Kaplan-Meier curves from 31 days to 3 years were almost identical between NSTEMI+CK and NSTEMI-CK (P=0.91). CONCLUSIONS: Despite smaller infarct size and better short-term outcomes, long-term outcomes of NSTEMI-CK after convalescence were as poor as those for NSTEMI+CK and worse than for STEMI.
BACKGROUND: According to troponin-based criteria of myocardial infarction (MI), patients without elevation of creatine kinase (CK), formerly classified as unstable angina (UA), are now diagnosed as non-ST-elevation MI (NSTEMI), but little is known about their outcomes.Methods and Results: Between July 2012 and March 2014, 3,283 consecutive patients with MI were enrolled. Clinical follow-up data were obtained up to 3 years. The primary endpoint was a composite of all-cause death, non-fatal MI, non-fatal stroke, cardiac failure and urgent revascularization for UA. There were 2,262 patients with ST-elevation MI (STEMI), 563 NSTEMI with CK elevation (NSTEMI+CK) and 458 NSTEMI without CK elevation (NSTEMI-CK). From day 0, Kaplan-Meier curves for the primary endpoint began to diverge in favor of NSTEMI-CK for up to 30 days. The 30-day event rate was significantly lower in patients with NSTEMI-CK (3.3%) than in STEMI (8.6%, P<0.001) and NSTEMI+CK (9.9%, P<0.001). Later, the event curves diverged in favor of STEMI. The event rate from 31 days to 3 years was significantly lower in patients with STEMI (19.8%) than in NSTEMI+CK (33.6%, P<0.001) and NSTEMI-CK (34.2%, P<0.001). Kaplan-Meier curves from 31 days to 3 years were almost identical between NSTEMI+CK and NSTEMI-CK (P=0.91). CONCLUSIONS: Despite smaller infarct size and better short-term outcomes, long-term outcomes of NSTEMI-CK after convalescence were as poor as those for NSTEMI+CK and worse than for STEMI.
Authors: Gloria M Gager; Ceren Eyileten; Marek Postula; Aleksandra Gasecka; Joanna Jarosz-Popek; Georg Gelbenegger; Bernd Jilma; Irene Lang; Jolanta Siller-Matula Journal: Front Cardiovasc Med Date: 2022-07-08