Survival after hospital discharge for ST-segment elevation and non-ST-segment elevation acute myocardial infarction: a population-based study

Abstract

BackgroundLimited recent data are available describing differences in long-term survival, and factors affecting prognosis, after ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI), especially from the more generalizable perspective of a population-based investigation. The objectives of this study were to examine differences in post-discharge prognosis after hospitalization for STEMI and NSTEMI, with a particular focus on factors associated with reduced long-term survival.MethodsWe reviewed the medical records of residents of the Worcester, MA, USA metropolitan area hospitalized at eleven central Massachusetts medical centers for acute myocardial infarction (AMI) during 2001, 2003, 2005, and 2007.ResultsA total of 3762 persons were hospitalized with confirmed AMI; of these, 2539 patients (67.5%) were diagnosed with NSTEMI. The average age of study patients was 70.3 years and 42.9% were women. Patients with NSTEMI experienced higher post-discharge death rates with 3-month, 1-year, and 2-year death rates of 12.6%, 23.5%, and 33.2%, respectively, compared to 6.1%, 11.5%, and 16.4% for patients with STEMI. After multivariable adjustment, patients with NSTEMI were significantly more likely to have died after hospital discharge (adjusted hazards ratio 1.28; 95% confidence interval 1.14–1.44). Several demographic (eg, older age) and clinical (eg, history of stroke) factors were associated with reduced long-term survival in patients with NSTEMI and STEMI.ConclusionsThe results of this study in residents of central Massachusetts suggest that patients with NSTEMI are at higher risk for dying after hospital discharge, and several subgroups are at particularly increased risk.

Poor long-term outcome in acute coronary syndrome in a real-life setting: Ten-year outcome of the TACOS study

“…Compared with STEMI patients, those with NSTE-MI tend to be older and have more comorbidity. In the Worcester Heart Attack Study (WHAS) with a population 3,762 patients, post-discharge death rates in a sub-cohort with longer follow-up, 5-year death rates for STEMI (mean age for all patients 65.5 years) and NSTEMI (mean age for all patients 72.6 years) were 30.2% and 52.4%, which are in the same range as in the present study: 32.4% for STEMI, 51.3% for NSTEMI [17].…”

“…There are two additional limitations typical for outcome studies with long follow-up in patients with cardiovascular diseases. The first limitation is the low rate of invasive procedures [17]. Especially in STEMI, the rate of invasive procedures during the index hospital stay in the present study was lower than what is typical for Western countries today.…”

Recent Trends in Hospitalization for Acute Myocardial Infarction in Beijing

“… 5 , 24 , 34 However, a substantial gap in the in-hospital treatment for patients with NSTEMI was also found in studies in Europe and the United States. 2 , 35 , 36 Moreover, the long-term mortality for patients with NSTEMI is reportedly worse than that for patients with STEMI because the former are considerably older and have a higher prevalence of cardiovascular comorbidities. 2 , 35 , 36 These findings, in line with ours, indicate that there is an urgent need to improve the quality of care for patients with NSTEMI, a condition that is on the rise.…”

Long-term outcomes in high-risk patients with non-ST-segment elevation myocardial infarction

“…Mortality rates after myocardial infarction (MI) have decreased over the last 20 years [ 3 ], but improvement in outcomes differs between ST-segment elevation myocardial infarction (STEMI) and NSTEMI patients. Compared with STEMI patients, NSTEMI patients have lower short-term mortality rates, and higher rates of long-term mortality, even after adjustment for risk factors [ 2 , 4 ]. One-year mortality rates for STEMI patients have declined recently, but in NSTEMI patients, the trend is inconsistent and less marked [ 3 ].…”