European Heart Journal Advance Access originally published online on April 5, 2007
European Heart Journal 2007 28(12):1409-1417; doi:10.1093/eurheartj/ehm031
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STEMI and NSTEMI: are they so different? 1 year outcomes in acute myocardial infarction as defined by the ESC/ACC definition (the OPERA registry)
1 Institut de Cardiologie and INSERM U856, Pitié-Salpétrière University Hospital, AP-HP, 47 Boulevard de l'Hôpital, Paris 75013, France
2 Institut Pasteur and INSERM U508, Lille, France
3 University Hospital and INSERM ERI9, Lille, France
4 THERAPHARM Recherches, Boulogne-Billancourt, France
5 Pfizer, Paris, France
6 Clinical Research Unit, Fernand Vidal Hospital, Paris, France
Received 3 October 2006; revised 15 February 2007; accepted 23 February 2007; online publish-ahead-of-print 5 April 2007.
* Corresponding author. Tel: +33 1 42 16 30 06; fax: +33 1 42 16 29 31; E-mail address: gilles.montalescot{at}psl.aphp.fr
See page 1403 for the editorial comment on this article (doi:10.1093/eurheartj/ehm159)
Aims: The ESC/ACC redefined myocardial infarction as any amount of necrosis caused by ischaemia. The aim of this study was to describe the management and outcomes using ‘real-world’ data taking the new definition of acute myocardial infarction into account.
Methods and results: A total of 2151 consecutive patients (76.0% men) with a myocardial infarction were enrolled at 56 centres in France. The median delay to presentation was shorter in patients with ST-segment elevation myocardial infarction (STEMI) vs. non-STEMI (NSTEMI) (4 vs. 7 h, P < 0.0001). STEMI patients were more likely to receive fibrinolysis (28.9 vs. 0.7%, P < 0.0001) or undergo PCI (71.0 vs. 51.6%, P < 0.0001) but less likely to have bypass surgery (3.1 vs. 4.9%, P < 0.05). At discharge, patients with STEMI received more aggressive secondary prevention therapies than those with NSTEMI, which was not supported by differences in disease severity. A total of 1878 patients were followed-up for 1 year: 36.7% of STEMI and 41.5% of NSTEMI patients were rehospitalized (P = 0.05); 16% in both groups were revascularized. In-hospital mortality was similar (4.6 vs. 4.3%), and 1-year mortality was 9.0% in STEMI patients and 11.6% in NSTEMI patients (Log-Rank P = 0.09). Independent correlates of in-hospital mortality were untreated dyslipidaemia, advanced age, diabetes, and low blood pressure. The strongest predictors of 1-year mortality were heart failure and age. Similar predictors were found in STEMI and NSTEMI subgroups.
Conclusions: Despite different management, patients with STEMI and NSTEMI have similar prognoses and independent correlates of outcome. These findings support the new definition of myocardial infarction.
Key Words: Myocardial infarction • Death • Predictors
These data were presented at the European society of cardiology/world congress of cardiology in Barcelona, Spain, on 4 September 2006.
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