Author + information
- Ju Yeol Baek1,
- Seung-Woon Rha2,
- Byoung Geol Choi2,
- Yong Mo Yang3,
- Won Ik Lee3,
- Se Yeon Choi2,
- Cheol Ung Choi2 and
- Dong Joo Oh4
Patients who have had a myocardial infarction (MI) remain at higher risk for ischemic events over the long term period. However clinical impact of stabilized MI following successful percutaneous coronary intervention (PCI) after 1 year is not clearly elucidated yet.
We pooled 3,583 patients underwent PCI with drug-eluting stents (DESs). Of them, 658 (18.4%) was ST-elevation MI (STEMI), 632 (17.6%) non-ST segment elevation MI (NSTEMI), 1,297 (36.2%) unstable angina (UA), and 996 (27.8%) stable angina (SA) as clinical presentation. We compared 0-1 year and 1-5 years composite of cardiac death (CD) and MI among 4 groups.
With survival analysis of 0-1 year clinical follow up, a stepwise increase of the composite of CD and MI was observed in the transition from SA to STEMI. (SA; 1.2% vs. UA; 1.4% vs. NSTEMI; 5.2% vs. STEMI; 8.1%; Log-Rank < 0.001). Even in the comparison of 1-5 year long term clinical outcomes between stabilized patients with MI and angina pectoris, there was the same pattern of transition (SA; 1.7% vs. UA; 2.0% vs. NSTEMI; 3.9% vs. STEMI; 4.3%; Log-Rank = 0.002, Figure). After Unadjusted cox-proportional analysis, STEMI and NSTEMI were independently associated with greater risk of 1-5 year CD or MI rather than SA (STEMI; hazard ratio [HR] 2.70; 95% confidence interval [CI] 1.361 to 5.364; p = 0.004, NSTEMI; HR 2.45; 95% CI 1.201 to 5.001; p = 0.014), whereas UA were not significantly influenced on CD or MI (HR 1.27; 95% CI 0.633-2.558; p = 0.499).
Across the clinical spectrum of different coronary artery disease, STEMI and NSTEMI were associated with a greater risk of long-term CD or MI at 1 year. Even after stabilized by PCI in STEMI and NSTEMI patients beyond 1 year, the incidence of CD or MI was still higher than that of the patients with UA and SA.
CORONARY: Acute Coronary Syndromes