High-risk non-ST-segment elevation myocardial infarction versus ST-segment elevation myocardial infarction: same behaviour and outcome?

Despite advances in the treatment of acute coronary syndromes (ACS) a large proportion of patients do not receive adequate treatment. In most cases, myocardial infarction with ST-segment elevation myocardial infarction (STEMI) is associated with thrombotic occlusion of a major coronary artery, and 30-day mortality is higher than for patients with non-ST-segment elevation myocardial infarction (NSTEMI). In patients with NSTEMI, however, the mortality rate increases after discharge, becoming close to that seen in STEMI patients at 6 months. Whereas patients with STEMI usually undergo emergent revascularization, the clinical scenario in NSTEMI is extremely variable and, in most cases, high-risk patients do not undergo coronary angiography at the times recommended in the European Society of Cardiology guidelines. Unlike NSTEMI, STEMI is associated with a very high risk of mortality in 30% of cases, whereas the remaining 70% of cases have a short-term mortality risk of less than 5%. The application of accurate models for risk prediction may significantly improve survival in these patients, thus avoiding emergent revascularization in low to medium-risk patients. This approach may lead to a redistribution of care across the spectrum of ACS, thus giving priority when the risk/benefit ratio is higher, independent of electrocardiogram results at presentation.