AIMS:

The prognosis of STEMI and NSTEMI patients stratified according to invasive angiographic findings of occlusion myocardial infarction (OMI) remains unclear. This retrospective single-center study compared all-cause mortality outcomes of STEMI, NSTEMI-OMI, and NSTEMI-NOMI.

METHODS AND RESULTS:

Demographics, clinical and procedure related data were pooled for all patients with an index ACS event between January 2011 and May 2021. Patients were classified based on biomarker and angiographic presence of OMI and compared by Kaplan Meier survival analysis of all-cause mortality at 1-year and landmark analysis up to 5 years after the ACS event. A total of 9,943 patients [64.1 ± 14.2 years, 6182 (62.2%) males] were included and classified into STEMI (n=507), NSTEMI-OMI (n=685), NSTEMI-NOMI (n=1,535) and MI ruled-out (n=7,216). All groups had comparable baseline demographics and invasive angiographic characteristics. The median time to coronary angiography and intervention was 45.8 hours compared to 1.4 and 16.3 hours for STEMI and NSTEMI-OMI, respectively (p<0.001). At one year, the primary outcome of all-cause death was 18.1% for NSTEMI-OMI as compared to 9.9% in STEMI patients (hazard ratio, 1.84; 95% CI, 1.32 to 2.55; p<0.001) and 7.9% in NSTEMI-NOMI patients (hazard ratio, 0.79; 95% CI, 0.56 to 1.09; p=0.150). Poor clinical outcomes of NSTEMI-OMI compared to STEMI persisted in age and gender-adjusted and landmark analyses beyond 1 year (hazard ratio, 2.59; 95% CI, 1.75 to 3.82; p<0.001).

CONCLUSION:

Despite similar baseline demographics and invasive angiographic findings, patients with NSTEMI-OMI have worse short and long-term all-cause mortality compared to STEMI. These findings strongly urge for refining the precision and timely triage of ACS patients.