Management and outcome of patients with non-ST elevation myocardial infarction and intercurrent non-coronary precipitating events.
Dual antiplatelet therapy
Invasive strategy
Mortality
Myocardial infarction
Precipitating event
Journal
European heart journal. Acute cardiovascular care
ISSN: 2048-8734
Titre abrégé: Eur Heart J Acute Cardiovasc Care
Pays: England
ID NLM: 101591369
Informations de publication
Date de publication:
27 Dec 2022
27 Dec 2022
Historique:
received:
15
06
2022
revised:
25
07
2022
accepted:
11
10
2022
pubmed:
15
10
2022
medline:
30
12
2022
entrez:
14
10
2022
Statut:
ppublish
Résumé
To evaluate the effect of an intercurrent non-coronary illness on the management and outcome of patients with non-ST-segment elevation myocardial infarction (NSTEMI). Consecutive hospitalized patients with a primary diagnosis of NSTEMI between August 2008 and December 2019 at Sheba Medical Center. All patients' records were reviewed for the presence of a non-coronary precipitating event (NCPE): a major intercurrent acute non-coronary illness or condition, either cardiac or non-cardiac. The primary outcome was all-cause mortality. Cox regression with interaction analysis was applied. Final study population comprised 6491 patients, of whom 2621 (40%) had NCPEs. Patients with NCPEs were older (77 vs. 69 years) and more likely to have comorbidities. The most prevalent event was infection (35%, n = 922). During a median follow-up of 30 months, 2529 patients died. Patients with NCPEs were 43% more likely to die during follow-up in a multivariable model (95% CI: 1.31-1.55). Invasive strategy was associated with a 55% lower mortality among patients without NCPE and only 44% among patients with NCPE (P for interaction < 0.001). Dual antiplatelet therapy (DAPT) was associated with a 20% lower mortality in patients without NCEP and a non-significant mortality difference among patients with NCPE (P for interaction = 0.014). Sub-analysis by the specific NCPE showed the highest mortality risk among patients with infectious precipitant. The lower mortality associated with invasive strategy was not observed in this subgroup. Among NSTEMI patients, the presence of an NCPE is associated with poor survival and modifies the effect of management strategies.
Identifiants
pubmed: 36229932
pii: 6760811
doi: 10.1093/ehjacc/zuac134
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
922-930Informations de copyright
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.
Déclaration de conflit d'intérêts
Conflict of interest: None declared.