Long-Term Clinical Outcomes according to Initial Management and Thrombolysis In Myocardial Infarction Risk Score in Patients with Acute Non-ST-Segment Elevation Myocardial Infarction

다국어 초록 (Multilingual Abstract)

Purpose: There is still debate about the timing of revascularization in patients with acute non-ST-segment elevation myocardial infarction (NSTEMI). We analyzed the long-term clinical outcomes of the timing of revascularization in patients with acute NSTEMI obtained from the Korea Acute Myocardial Infarction Registry (KAMIR). Materials and Methods: 2,845 patients with acute NSTEMI (65.6 ± 12.5 years, 1,836 males) who were enrolled in KAMIR were included in the present study. The therapeutic strategy of NSTEMI was categorized into early invasive (within 48 hours, 65.8 ± 12.6 years, 856 males)and late invasive treatment (65.3 ± 12.1 years, 979 males). The initial- and long-term clinical outcomes were compared between two groups according to the level of Thrombolysis In Myocardial Infarction (TIMI) risk score. Results:There were significant differences in-hospital mortality and the incidence of major adverse cardiac events during one-year clinical follow-up between two groups (2.1% vs. 4.8%, p < 0.001, 10.0% vs. 13.5%, p = 0.004, respectively).
According to the TIMI risk score, there was no significant difference of longterm clinical outcomes in patients with low to moderate TIMI risk score, but significant difference in patients with high TIMI risk score (≥ 5 points).
Conclusion: The old age, high Killip class, low ejection fraction, high TIMI risk score, and late invasive treatment strategy are the independent predictors for the long-term clinical outcomes in patients with NSTEMI.

참고문헌 (Reference)

1 Sabatine MS, "The thrombolysis in myocardial infarction risk score in unstable angina/non ST segment elevation myocardial infarction" 41 : 89S-95S, 2003

2 Westerhout CM, "Short-and long-term risk stratification in acute coronary syndromes: the added value of quantitative ST-segment depression and multiple biomarkers" 48 : 939-947, 2006

3 Yan AT, "ST-segment depression in non-ST elevation acute coronary syndromes: quantitative analysis may not provide incremental prognostic value beyond comprehensive risk stratification" 152 : 270-276, 2006

4 Tricoci P, "Patterns of guideline adherence and care delivery for patients with unstable angina and non-STsegment elevation myocardial infarction (from the CRUSADE Quality Improvement Initiative)" 98 : 30Q-35Q, 2006

5 Boden WE, "Outcomes in patients with acute non-Q-wave myocardial infarction randomly assigned to an invasive as compared with a conservative anagement strategy. Veterans Affairs Non-Q-Wave Infarction Strategies in Hospital (VANQWISH) Trial Investigators" 338 : 1785-1792, 1998

6 Wallentin L, "Outcome at 1 year after an invasive compared with a noninvasive strategy in unstable coronary-artery disease: the FRISC II invasive randomised trial. FRISC II Investigators. Fast Revascularisation during Instability in Coronary artery disease" 356 : 9-16, 2000

7 Kwon TG, "N-terminal pro-B-type natriuretic peptide is associated with adverse short-term clinical outcomes in patients with acute STelevation myocardial infarction underwent primary percutaneous coronary intervention" 133 : 173-178, 2009

8 Hirsch A, "Long-term outcome after an early invasive versus selective invasive treatment strategy in patients with non-STelevation acute coronary syndrome and elevated cardiac troponin T (the ICTUS trial): a follow-up study" 369 : 827-835, 2007

9 Fox KA, "Interventional versus conservative treatment for patients with unstable angina or non-ST-elevation myocardial infarction. The British Heart Foundation RITA 3 randomised trial. Randomized Intervention Trial of unstable Angina" 360 : 743-751, 2002

10 Cannon CP, "Intensive versus moderate lipid lowering with statins after acute coronary syndromes" 350 : 1495-1504, 2004

11 Cavallini C, "Impact of the elevation of biochemical markers of myocardial damage on long-term mortality after percutaneous coronary intervention: results of the CK-MB and PCI study" 26 : 1494-1498, 2005

12 Bassand JP, "Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes" 28 : 1598-1660, 2007

13 Lee KH, "Gender differences of success rate of percutaneous coronary intervention and short term cardiac events in Korea Acute Myocardial Infarction Registry" 130 : 227-234, 2008

14 "Effects of tissue plasminogen activator and a comparison of early invasive and conservative strategies in unstable angina and non-Q-wave myocardial infarction: results of the TIMI IIIB trial. Thrombolysis in Myocardial Ischemia" 89 : 1545-1556, 1994

15 Denardo SJ, "Effectiveness and safety of reduced-dose enoxaparin in non-ST-segment elevation acute coronary syndrome followed by antiplatelet therapy alone for percutaneous coronary intervention" 100 : 1376-1382, 2007

16 de Winter RJ, "Early invasive versus selectively invasive management for acute coronary syndromes" 353 : 1095-1104, 2005

17 Roe MT, "Creatine kinase-MB elevation after percutaneous coronary intervention predicts adverse outcomes in patients with acute coronary syndromes" 25 : 313-321, 2004

18 Cannon CP, "Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban" 344 : 1879-1887, 2001

19 Jones PH, "Clinical significance of recent lipid trials on reducing risk in patients with type 2 diabetes mellitus" 99 : 133B-140B, 2007

20 Jaffe AS, "Biomarkers in acute cardiac disease: the present and the future" 48 : 1-11, 2006

21 Gibson CM, "Association of glomerular filtration rate on presentation with subsequent mortality in non-ST-segment elevation acute coronary syndrome; observations in 13,307 patients in five TIMI trials" 25 : 1998-2005, 2004

22 Alexander KP, "Acute coronary care in the elderly, part I: Non-ST-segment-elevation acute coronary syndromes: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology" 115 : 2549-2569, 2007

23 Mehta RH, "Acute clopidogrel use and outcomes in patients with non-ST-segment elevation acute coronary syndromes undergoing coronary artery bypass surgery" 48 : 281-286, 2006

24 Braunwald E, "ACC/AHA guideline update for the management of patients with unstable angina and non-STsegment elevation myocardial infarction 2002: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Unstable Angina)" 106 : 1893-1900, 2002

25 Pollack CV Jr, "2007 Update to the ACC/AHA guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: implications for emergency department practice" 51 : 591-606, 2008

26 King SB 3rd, "2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines" 117 : 261-295, 2008