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

• Published in: Yonsei medical journal Vol. 51; no. 1; pp. 58 - 68
• Main Authors: Jeong, Hae Chang, Ahn, Youngkeun, Jeong, Myung Ho, Chae, Shung Chull, Hur, Seung Ho, Hong, Taek Jong, Kim, Young Jo, Seong, In Whan, Chae, Jei Keon, Rhew, Jay Young, Chae, In Ho, Cho, Myeong Chan, Bae, Jang Ho, Rha, Seung Woon, Kim, Chong Jin, Choi, Donghoon, Jang, Yang Soo, Yoon, Junghan, Chung, Wook Sung, Cho, Jeong Gwan, Seung, Ki Bae, Park, Seung Jung
• Format: Journal Article
• Language: English
• Published: Korea (South) Yonsei University College of Medicine 01.01.2010; 연세대학교의과대학
• Subjects: Age Factors; Aged; Angioplasty, Balloon, Coronary; Female; Fibrinolytic Agents - therapeutic use; Hemodynamics - drug effects; Humans; Male; Middle Aged; Multivariate Analysis; Myocardial Infarction - drug therapy; Myocardial Infarction - pathology; Myocardial Infarction - therapy; Original; Prospective Studies; Thrombolytic Therapy - methods; 의학일반; Myocardial infarction; TIMI risk score; invasive treatment; non-ST-segment elevation; prognosis
• ISSN: 0513-5796; 1976-2437
• DOI: 10.3349/ymj.2010.51.1.58

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). 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. 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). 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.