Yonsei Med J.  2010 Jan;51(1):58-68. 10.3349/ymj.2010.51.1.58.

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

• Jeong HC
• Ahn Y
• Jeong MH
• Chae SC
• Hur SH
• Hong TJ
• Kim YJ
• Seong IW
• Chae JK
• Rhew JY
• Chae IH
• Cho MC
• Bae JH
• Rha SW
• Kim CJ
• Choi D
• Jang YS
• Yoon J
• Chung WS
• Cho JG
• Seung KB
• Park SJ
• Other Korea Acute Myocardial Infarction Registry Investigators

• KMID: 1779607
• DOI: http://doi.org/10.3349/ymj.2010.51.1.58

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 long-term clinical outcomes in patients with low to moderate TIMI risk score, but significant difference in patients with high TIMI risk score (> or = 5 points). Conclusions: 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.

Keyword

Myocardial infarction; non-ST-segment elevation; invasive treatment; TIMI risk score; prognosis

MeSH Terms

Age Factors
Aged
Angioplasty, Transluminal, Percutaneous Coronary
Female
Fibrinolytic Agents/*therapeutic use
Hemodynamics/drug effects
Humans
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction/*drug therapy/pathology/therapy
Prospective Studies
Thrombolytic Therapy/*methods

Figure

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  Fig. 1 Primary end point (one-year major adverse cardiac events) according to the Thrombolysis In Myocardial Infarction (TIMI) risk score.

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  Fig. 2 Estimated rates and relative risk of the composite primary end points of death from cardiac or non cardiac causes, recurrent myocardial infarction, target vessel or non-target vessel or target lesion revascularization at one year according to subgroups.

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