Differences in mortality and causes of death between STEMI and NSTEMI in the early and late phases after acute myocardial infarction

Yasuaki Takeji; Hiroki Shiomi; Takeshi Morimoto; Ko Yamamoto; Yukiko Matsumura-Nakano; Kazuya Nagao; Ryoji Taniguchi; Kyohei Yamaji; Tomohisa Tada; Eri Toda Kato; Yusuke Yoshikawa; Yuki Obayashi; Satoru Suwa; Moriaki Inoko; Natsuhiko Ehara; Toshihiro Tamura; Tomoya Onodera; Hiroki Watanabe; Mamoru Toyofuku; Kenji Nakatsuma; Hiroki Sakamoto; Kenji Ando; Yutaka Furukawa; Yukihito Sato; Yoshihisa Nakagawa; Kazushige Kadota; Takeshi Kimura; CREDO-Kyoto AMI Registry Wave-2 Investigators

doi:10.1371/journal.pone.0259268

Differences in mortality and causes of death between STEMI and NSTEMI in the early and late phases after acute myocardial infarction

PLoS One. 2021 Nov 17;16(11):e0259268. doi: 10.1371/journal.pone.0259268. eCollection 2021.

Authors

Yasuaki Takeji¹, Hiroki Shiomi¹, Takeshi Morimoto², Ko Yamamoto¹, Yukiko Matsumura-Nakano¹, Kazuya Nagao³, Ryoji Taniguchi⁴, Kyohei Yamaji⁵, Tomohisa Tada⁶, Eri Toda Kato¹, Yusuke Yoshikawa¹, Yuki Obayashi¹, Satoru Suwa⁷, Moriaki Inoko⁸, Natsuhiko Ehara⁹, Toshihiro Tamura¹⁰, Tomoya Onodera¹¹, Hiroki Watanabe¹², Mamoru Toyofuku¹², Kenji Nakatsuma¹³, Hiroki Sakamoto⁶, Kenji Ando⁵, Yutaka Furukawa⁹, Yukihito Sato⁴, Yoshihisa Nakagawa¹⁴, Kazushige Kadota¹⁵, Takeshi Kimura¹; CREDO-Kyoto AMI Registry Wave-2 Investigators

Affiliations

¹ Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
² Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan.
³ Department of Cardiovascular Medicine, Osaka Red Cross Hospital, Osaka, Japan.
⁴ Department of Cardiology, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan.
⁵ Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
⁶ Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan.
⁷ Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Japan.
⁸ Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan.
⁹ Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
¹⁰ Department of Cardiology, Tenri Hospital, Tenri, Japan.
¹¹ Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan.
¹² Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan.
¹³ Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan.
¹⁴ Department of Cardiovascular Medicine, Shiga University of Medical Science Hospital, Otsu, Japan.
¹⁵ Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.

Abstract

Background: The detailed causes of death in non-ST-segment-elevation myocardial infarction (NSTEMI) have not been adequately evaluated compared to those in ST-segment elevation myocardial infarction (STEMI).

Methods: The study population was 6,228 AMI patients who underwent percutaneous coronary intervention (STEMI: 4,625 patients and NSTEMI: 1,603 patients). The primary outcome was all-cause death.

Results: Within 6 months after AMI, the adjusted mortality risk was not significantly different between NSTEMI patients and STEMI patients (HR: 0.83, 95%CI: 0.67-1.03, P = 0.09). Regarding the causes of death within 6 months after AMI, mechanical complications more frequently occurred in STEMI patients than in NSTEMI patients, while proportions of post resuscitation status on arrival and heart failure were higher in in NSTEMI patients than in STEMI patients. Beyond 6 months after AMI, the adjusted mortality risk of NSTEMI relative to STEMI was not significantly different. (HR: 1.04, 95%CI: 0.90-1.20, P = 0.59). Regarding causes of death beyond 6 months after AMI, almost half of deaths were cardiovascular causes in both groups, and breakdown of causes of death was similar between NSTEMI and STEMI.

Conclusion: The mortality risk within and beyond 6 months after AMI were not significantly different between STEMI patients and NSTEMI patients after adjusting confounders. Deaths due to post resuscitation status and heart failure were more frequent in NSTEMI within 6 months after AMI.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cause of Death
Humans
Middle Aged
Myocardial Infarction*
Non-ST Elevated Myocardial Infarction*
Percutaneous Coronary Intervention

Grants and funding

This study was supported by an educational grant from the Research Institute for Production Development (Kyoto, Japan). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.