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Prognosis Between ST-Elevation and Non-ST-elevation Myocardial Infarction in Older Adult Patients

Background: Whether there is a difference in prognosis between elderly patients with ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) remains mysterious. Methods: We conducted a retrospective cohort study by analyzing the data in the Longitudinal Health...

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Autores principales: Chang, Shih-Sheng, Lu, Chiung-Ray, Chen, Ke-Wei, Kuo, Zhe-Wei, Yu, Shao-Hua, Lin, Shih-Yi, Shi, Hong-Mo, Yip, Hei-Tung, Kao, Chia-Hung
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8761910/
https://www.ncbi.nlm.nih.gov/pubmed/35047571
http://dx.doi.org/10.3389/fcvm.2021.749072
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author Chang, Shih-Sheng
Lu, Chiung-Ray
Chen, Ke-Wei
Kuo, Zhe-Wei
Yu, Shao-Hua
Lin, Shih-Yi
Shi, Hong-Mo
Yip, Hei-Tung
Kao, Chia-Hung
author_facet Chang, Shih-Sheng
Lu, Chiung-Ray
Chen, Ke-Wei
Kuo, Zhe-Wei
Yu, Shao-Hua
Lin, Shih-Yi
Shi, Hong-Mo
Yip, Hei-Tung
Kao, Chia-Hung
author_sort Chang, Shih-Sheng
collection PubMed
description Background: Whether there is a difference in prognosis between elderly patients with ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) remains mysterious. Methods: We conducted a retrospective cohort study by analyzing the data in the Longitudinal Health Insurance Database (LHID) in Taiwan to explore differences between STEMI and NSTEMI with respect to in-hospital and long-term (3-year) outcomes among older adult patients (aged ≥65 years). Patients were further stratified based on whether they received coronary revascularization. Results: In total, 5,902 patients aged ≥65 years with acute myocardial infarction (AMI) who underwent revascularization (2,254) or medical therapy alone (3,648) were included. In the revascularized group, no difference was observed in cardiovascular (CV) and all-cause mortality during hospitalization or at 3-year follow-up between the two AMIs. Conversely, in the non-revascularized group, patients with NSTEMI had higher crude odds ratio (cOR) for all-cause death during hospitalization [cOR: 1.33, 95% confidence interval (CI) = 1.07–1.65] and at 3-year follow-up (cOR: 1.47, 95% CI = 1.21–1.91) relative to patients with STEMI. However, after multivariable adjustments, only NSTEMI indicated fewer in-hospital CV death [adjusted odds ratio (aOR): 0.75, 95% CI = 0.58–0.98] than STEMI in non-revascularized group. Moreover, major bleeding was not different between patients with STEMI or NSTEMI aged ≥65 years old. Conclusion: Classification of AMI is not associated with the difference of in-hospital or 3-year CV and all-cause death in older adult patients received revascularization. In a 3-year follow-up period, STEMI was an independent predictor of a higher incidence of revascularization after the index event. Non-ST-elevation myocardial infarction had more incidence of MACE than patients with STEMI did in both treatment groups.
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spelling pubmed-87619102022-01-18 Prognosis Between ST-Elevation and Non-ST-elevation Myocardial Infarction in Older Adult Patients Chang, Shih-Sheng Lu, Chiung-Ray Chen, Ke-Wei Kuo, Zhe-Wei Yu, Shao-Hua Lin, Shih-Yi Shi, Hong-Mo Yip, Hei-Tung Kao, Chia-Hung Front Cardiovasc Med Cardiovascular Medicine Background: Whether there is a difference in prognosis between elderly patients with ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) remains mysterious. Methods: We conducted a retrospective cohort study by analyzing the data in the Longitudinal Health Insurance Database (LHID) in Taiwan to explore differences between STEMI and NSTEMI with respect to in-hospital and long-term (3-year) outcomes among older adult patients (aged ≥65 years). Patients were further stratified based on whether they received coronary revascularization. Results: In total, 5,902 patients aged ≥65 years with acute myocardial infarction (AMI) who underwent revascularization (2,254) or medical therapy alone (3,648) were included. In the revascularized group, no difference was observed in cardiovascular (CV) and all-cause mortality during hospitalization or at 3-year follow-up between the two AMIs. Conversely, in the non-revascularized group, patients with NSTEMI had higher crude odds ratio (cOR) for all-cause death during hospitalization [cOR: 1.33, 95% confidence interval (CI) = 1.07–1.65] and at 3-year follow-up (cOR: 1.47, 95% CI = 1.21–1.91) relative to patients with STEMI. However, after multivariable adjustments, only NSTEMI indicated fewer in-hospital CV death [adjusted odds ratio (aOR): 0.75, 95% CI = 0.58–0.98] than STEMI in non-revascularized group. Moreover, major bleeding was not different between patients with STEMI or NSTEMI aged ≥65 years old. Conclusion: Classification of AMI is not associated with the difference of in-hospital or 3-year CV and all-cause death in older adult patients received revascularization. In a 3-year follow-up period, STEMI was an independent predictor of a higher incidence of revascularization after the index event. Non-ST-elevation myocardial infarction had more incidence of MACE than patients with STEMI did in both treatment groups. Frontiers Media S.A. 2022-01-03 /pmc/articles/PMC8761910/ /pubmed/35047571 http://dx.doi.org/10.3389/fcvm.2021.749072 Text en Copyright © 2022 Chang, Lu, Chen, Kuo, Yu, Lin, Shi, Yip and Kao. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Chang, Shih-Sheng
Lu, Chiung-Ray
Chen, Ke-Wei
Kuo, Zhe-Wei
Yu, Shao-Hua
Lin, Shih-Yi
Shi, Hong-Mo
Yip, Hei-Tung
Kao, Chia-Hung
Prognosis Between ST-Elevation and Non-ST-elevation Myocardial Infarction in Older Adult Patients
title Prognosis Between ST-Elevation and Non-ST-elevation Myocardial Infarction in Older Adult Patients
title_full Prognosis Between ST-Elevation and Non-ST-elevation Myocardial Infarction in Older Adult Patients
title_fullStr Prognosis Between ST-Elevation and Non-ST-elevation Myocardial Infarction in Older Adult Patients
title_full_unstemmed Prognosis Between ST-Elevation and Non-ST-elevation Myocardial Infarction in Older Adult Patients
title_short Prognosis Between ST-Elevation and Non-ST-elevation Myocardial Infarction in Older Adult Patients
title_sort prognosis between st-elevation and non-st-elevation myocardial infarction in older adult patients
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8761910/
https://www.ncbi.nlm.nih.gov/pubmed/35047571
http://dx.doi.org/10.3389/fcvm.2021.749072
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