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KMID : 0311120100510010058
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Yonsei Medical Journal
2010 Volume.51 No. 1 p.58 ~ p.68
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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
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Jeong Hae-Chang
Seong In-Whan
Yoon Jung-Han
Chae Jei-Keon
Hur Seung-Ho
Rhew Jay-Young
Hong Taek-Jong
Kim Young-Jo
Seung Ki-Bae
Chae Shung-Chul
Chae In-Ho
Cho Jeong-Gwan
Ahn Young-Keun
Jeong Myung-Ho
Cho Myeong-Chan
Bae Jang-Ho
Rha Seung-Woon
Kim Chong-Jin
Choi Dong-Hoon
Jang Yang-Soo
Chung Wook-Sung
Park Seung-Jung
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Abstract
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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 (≥ 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.
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KEYWORD
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Myocardial infarction, non-ST-segment elevation, invasive treatment, TIMI risk score, prognosis
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