Patients with ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) are
increasingly being treated with percutaneous coronary intervention (PCI) and we sought
to determine risk of adverse outcomes by type of MI. Patients enrolled in the National
Heart, Lung, and Blood Institute Dynamic Registry from 1999 to 2004 who presented
with an acute MI as an indication for PCI were studied. Baseline data and in-hospital
and 1-year outcomes were compared based on ST-segment elevation (STEMI, n = 903; NSTEMI,
n = 583) at presentation. Patients with STEMI were younger, had fewer co-morbidities,
and had less extensive coronary artery disease than did patients with NSTEMI. Angiographic
success and periprocedural complications were similar by MI type. In-hospital coronary
artery bypass grafting, stroke, bleeding and recurrent MI were similar but mortality
was higher in patients with STEMI (4.0% vs 1.4%, p = 0.004). Cardiogenic shock was
associated with the greatest risk of in-hospital death (odds ratio 26.7, 95% confidence
interval 11.4 to 62.3, p = 0.0001), but STEMI was also independently predictive of
mortality. At 1 year, there was no influence of MI type on outcome. Age, cardiogenic
shock, renal disease, peripheral vascular disease, and cancer were predictive of death
and MI. Multivessel disease and a larger number of >50% lesions were associated with
the need for repeat revascularization. In conclusion, STEMI was associated with a
higher likelihood of in-hospital death than was NSTEMI, but long-term outcomes after
PCI were independent of MI type. At 1 year, associated co-morbidities were strongly
associated with death and MI, whereas only angiographic characteristics predicted
the need for repeat revascularization.