Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea.
Department of Cardiology, Yanbian University Hospital, Yanji, China.
Yonsei Med J. 2021 May;62(5):400-408. doi: 10.3349/ymj.2021.62.5.400.
This study aimed to compare mortality rates after discharge between the patients with non-ST-elevation myocardial infarction (NSTEMI) and those with ST-elevation myocardial infarction (STEMI), and identify each mortality risk factors in these two types of myocardial infarction.
Between 2011 and 2015, 13105 consecutive patients were enrolled in the Korea Acute Myocardial Infarction-National Institute of Health registry (KAMIR-NIH); 12271 patients with acute myocardial infarction met the inclusion criteria and were further stratified into the STEMI (n=5828) and NSTEMI (n=6443) groups. The occurrence of mortality and cardiac mortality at 3 years were compared between groups, and the factors associated with mortality for NSTEMI and STEMI were evaluated.
The comparison between these two groups and long-term follow-up outcomes showed that the cumulative rates of all-cause and cardiac mortality were higher in the NSTEMI group than in the STEMI group [all-cause mortality: 10.9% vs. 5.8%; hazards ratio (HR), 0.464; 95% confidence interval (CI), 0.359-0.600, <0.001; cardiac mortality: 6.6% vs. 3.5%, HR, 0.474; 95% CI, 0.344-0.654, <0.001, respectively). In the NSTEMI group, low left ventricular ejection fraction (LVEF; <40%), no percutaneous coronary intervention (PCI), old age (≥65 years), and low hemoglobin level (<12 g/dL) were identified as risk factors for 3-year mortality. In the STEMI group, old age, low glomerular filtration rate (<60 mL/min/1.73 m²), low LVEF, high heart rate (>100 beats/min), no PCI, and low hemoglobin level were identified as the risk factors for 3-year mortality.
The NSTEMI group had higher mortality compared to the STEMI group during the 3-year clinical follow-up after discharge. Low LVEF and no PCI were the main risk factors for mortality in the NSTEMI group. In contrast, old age and renal dysfunction were the risk factors for long-term mortality in the STEMI group.
本研究旨在比较非 ST 段抬高型心肌梗死（NSTEMI）和 ST 段抬高型心肌梗死（STEMI）患者出院后的死亡率，并确定这两种类型心肌梗死的各自死亡风险因素。
2011 年至 2015 年间，连续纳入 13105 例韩国急性心肌梗死-国立卫生研究院登记处（KAMIR-NIH）患者；12271 例急性心肌梗死患者符合纳入标准，并进一步分为 STEMI（n=5828）和 NSTEMI（n=6443）组。比较两组患者的 3 年死亡率和心脏死亡率，并评估 NSTEMI 和 STEMI 患者死亡相关因素。
两组比较及长期随访结果显示，NSTEMI 组全因死亡率和心脏死亡率均高于 STEMI 组[全因死亡率：10.9% vs. 5.8%；危险比（HR），0.464；95%置信区间（CI），0.359-0.600，<0.001；心脏死亡率：6.6% vs. 3.5%，HR，0.474；95%CI，0.344-0.654，<0.001]。在 NSTEMI 组中，左心室射血分数（LVEF）<40%、未行经皮冠状动脉介入治疗（PCI）、年龄较大（≥65 岁）和低血红蛋白水平（<12 g/dL）被确定为 3 年死亡的危险因素。在 STEMI 组中，年龄较大、肾小球滤过率（GFR）<60 mL/min/1.73 m²、LVEF 较低、心率较高（>100 次/分）、未行 PCI 和低血红蛋白水平被确定为 3 年死亡的危险因素。
与 STEMI 组相比，NSTEMI 组在出院后 3 年的临床随访期间死亡率更高。LVEF 降低和未行 PCI 是 NSTEMI 组死亡的主要危险因素。相反，年龄较大和肾功能障碍是 STEMI 组长期死亡的危险因素。
