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(Circulation. 2009;119:3110-3117.)
© 2009 American Heart Association, Inc.

Interventional Cardiology

Long-Term Mortality of Patients Undergoing Cardiac Catheterization for ST-Elevation and Non-ST-Elevation Myocardial Infarction

Mark Y. Chan, MBBS, MHS; Jie L. Sun, MS; L. Kristin Newby, MD, MHS; Linda K. Shaw, MS; Min Lin, PhD; Eric D. Peterson, MD, MPH; Robert M. Califf, MD; David F. Kong, MD; Matthew T. Roe, MD, MHS

From the National University Heart Centre, Singapore, Singapore (M.Y.C.); Montreal Heart Institute, Montreal, Quebec, Canada (M.Y.C.); Duke Clinical Research Institute, Durham, NC (J.L.S., L.K.N., L.K.S., M.L., E.D.P., D.F.K., M.T.R.); and Duke Translational Medicine Institute, Durham, NC (R.M.C.).

Correspondence to Dr Mark Y. Chan, MBBS, MHS, National University Heart Center, 5 Lower Kent Ridge Road, Singapore, Singapore 119074. E-mail chanyymark{at}gmail.com

Received June 19, 2008; accepted April 24, 2009.

Background— There are limited contemporary data comparing long-term outcomes after cardiac catheterization for ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI).

Methods and Results— We studied patients undergoing cardiac catheterization for STEMI (n=2413) and NSTEMI (n=1974) between 1999 and 2005 with at least 1 significant coronary lesion 75%. We compared adjusted mortality rates over restricted time intervals and the differential impact of early revascularization on mortality stratified by ST-elevation status. Between 1999 and 2007, 1274 patients died, with a median follow-up of 4 years. A piece-wise analysis showed a higher adjusted mortality risk for STEMI during the first 2 months (adjusted hazard ratio, 1.85; 95% confidence interval, 1.45 to 2.38) and a lower adjusted mortality risk for STEMI after 2 months (adjusted hazard ratio, 0.68; 95% confidence interval, 0.59 to 0.83). Compared with late or no revascularization, early revascularization was associated with a lower adjusted risk of mortality for both STEMI (adjusted hazard ratio, 0.73; 95% confidence interval, 0.58 to 0.90) and NSTEMI (adjusted hazard ratio, 0.76; 95% confidence interval, 0.65 to 0.89) (P for interaction=0.22).

Conclusions— Among a contemporary cohort of acute MI patients with significant coronary disease during cardiac catheterization, STEMI was associated with a higher risk of short-term mortality, but NSTEMI was associated with a higher risk of long-term mortality. Early revascularization was associated with a similar improvement in long-term outcomes for both STEMI and NSTEMI. These data suggest that in clinical investigations of early revascularization among patients with NSTEMI, extended follow-up may be necessary to demonstrate treatment benefit.

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