Abstract: P1341
Long-term mortality in patients with ST-elevation vs. non-ST-elevation acute myocardial infarction: a real world clinical scenario

Authors:
L. Saaby1, T.S. Poulsen1, S. Hosbond1, O. Gerke2, A.C.P. Diederichsen1, T.B. Larsen3, J. Hallas4, K. Thygesen5, H. Mickley1, 1Odense University Hospital, Department of Cardiology B - Odense - Denmark, 2Odense University Hospital, Department of Nuclear Medicine - Odense - Denmark, 3Aalborg Hospital of the Aarhus University Hospital - Aalborg - Denmark, 4University of Southern Denmark, Clinical Pharmacology - Odense - Denmark, 5Aarhus University Hospital, Department of Cardiology - Aarhus - Denmark,

Topic(s):
Post infarction period
Citation:
European Heart Journal ( 2013 ) 34 ( Abstract Supplement ), 251

Purpose: Acute myocardial infarction (MI) is categorized into ST-elevation MI (STEMI) or non-ST-elevation MI (NSTEMI). Earlier mortality data mainly originate from large-scale clinical trials or voluntary based registries and may be hampered by selection. In a routine clinical setting we set out to assess the relative occurrence of STEMI vs. NSTEMI and to determine long-term mortality.

Methods: During a one-year period we prospectively studied unselected patients (pts) admitted to a 1000-bed university hospital with a local catchment area of 300.000 residents. All pts having troponin I measured were included. Pts transferred from other hospitals were excluded. The diagnosis of MI was according to the criteria of the universal definition. Pts with new left bundle branch block were designated as a STEMI. Follow-up was at least one year, and all cause mortality was registered using the National Civil Registration System Registry.

Results: From January 2010 to January 2011 all together 7230 pts had troponin I measured. A total of 3762 pts qualified for inclusion, and 479 had acute MI: STEMI in 133 (28%), and NSTEMI in 346 (72%). STEMI pts were younger (68±14 vs. 72±13 yrs) (p=0.002) and had significantly less co-morbidity (prior AMI, coronary revascularization, heart failure, stroke, PAD and reduced kidney function). STEMI pts more frequently had one-vessel disease: 61% vs. 30% (p<0.01). During a median follow-up of 2.1 years 150 pts died. One-year mortality in STEMI pts was 14% vs. 27% in NSTEMI. At follow-up 20% of STEMI pts had died vs. 36% of NSTEMI pts (p<0.001).

Conclusion: The relative occurrence of pts with STEMI continues to decrease and comprises about one-fourth of MIs. A two-fold increased mortality rate in NSTEMI as compared with STEMI pts is observed during long-term follow-up.

Long-term mortality in STEMI vs. NSTEMI
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