Spadafora Luigi, Pastena Paola, Cacciatore Stefano, Betti Matteo, Biondi-Zoccai Giuseppe, D'Ascenzo Fabrizio, De Ferrari Gaetano Maria, De Filippo Ovidio, Versaci Francesco, Sciarretta Sebastiano, Frati Giacomo, Fiorentino Francesco, Borgi Marco, Pierucci Nicola, Sabouret Pierre, Ajmone Francesco, Lauretti Attilio, Russo Federico, Polimeni Alberto, Banach Maciej, Panichella Giorgia, Bernardi Marco
Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
UOC UTIC Emodinamica e Cardiologia, Ospedale Santa Maria Goretti, Latina, Italy.
Am J Cardiovasc Drugs. 2025 Jun 24. doi: 10.1007/s40256-025-00739-8.
Whether ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) carry distinct prognoses after discharge remains a matter of debate. This study aimed to compare 1-year clinical outcomes between patients with STEMI and NSTEMI in a large, real-world cohort.
Among 23,270 patients with acute coronary syndrome enrolled in the international PRAISE registry between 2003 and 2019, we included 21,789 patients with a diagnosis of either STEMI or NSTEMI. Clinical characteristics, discharge medications, and outcomes at 1 year were analyzed. The primary outcomes were all-cause mortality, re-infarction, and major bleeding. Multivariable logistic regression and propensity score matching were used to adjust for confounding. Subgroup and interaction analyses were also performed.
The cohort included 12,365 patients with STEMI and 9424 patients with NSTEMI. At baseline, patients with NSTEMI had more comorbidities, cardiovascular risk factors (except diabetes), and prior revascularization. Patients with STEMI were more frequently treated with statins, beta-blockers, and renin-angiotensin-aldosterone system inhibitors at discharge. At 1-year follow-up, overall outcomes were comparable between groups. Nonfatal reinfarction occurred more frequently in patients with NSTEMI (3.4% versus 2.8%, p = 0.022), but this association was not significant after adjustment (odds ratio [OR] 0.90, 95% confidence interval [CI] 0.65-1.24, p = 0.519). Results from propensity score-matched analyses confirmed the absence of prognostic differences. Subgroup analyses revealed significant interactions for diabetes mellitus and completeness of revascularization.
After accounting for clinical and therapeutic variables, 1-year outcomes were largely similar in patients with STEMI and NSTEMI. Differences in reinfarction risk appear to be driven by baseline characteristics and treatment patterns, rather than infarct type itself.
ST段抬高型心肌梗死（STEMI）和非ST段抬高型心肌梗死（NSTEMI）出院后的预后是否不同仍存在争议。本研究旨在比较大型真实世界队列中STEMI和NSTEMI患者的1年临床结局。
在2003年至2019年纳入国际PRAISE注册研究的23270例急性冠状动脉综合征患者中，我们纳入了21789例诊断为STEMI或NSTEMI的患者。分析了临床特征、出院用药情况及1年时的结局。主要结局为全因死亡率、再梗死和大出血。采用多变量逻辑回归和倾向评分匹配来调整混杂因素。还进行了亚组分析和交互分析。
该队列包括12365例STEMI患者和9424例NSTEMI患者。在基线时，NSTEMI患者有更多的合并症、心血管危险因素（糖尿病除外）和既往血运重建史。STEMI患者出院时更频繁地接受他汀类药物、β受体阻滞剂和肾素-血管紧张素-醛固酮系统抑制剂治疗。在1年随访时，两组的总体结局相当。NSTEMI患者非致命性再梗死的发生率更高（3.4%对2.8%，p = 0.022），但调整后这种关联不显著（优势比[OR] 0.90，95%置信区间[CI] 0.65 - 1.24，p = 0.519）。倾向评分匹配分析结果证实不存在预后差异。亚组分析显示糖尿病和血运重建完整性存在显著交互作用。
在考虑临床和治疗变量后，STEMI和NSTEMI患者的1年结局在很大程度上相似。再梗死风险的差异似乎由基线特征和治疗模式驱动，而非梗死类型本身。
