Clinico - functional particularities of deceased patients with STEMI and NSTEMI 12 months after revascularization

Abstract

Introduction: Acute myocardial infarction remains a leading cause of cardiovascular mortality worldwide [1 ]. However, ST-elevation MI (STEMI) and non-ST-elevation MI (NSTEMI) patients differ in clinical profile - STEMIs often cause greater acute myocardial damage, whereas NSTEMIs tend to occur in older patients with more comorbidities [1]. These differences may impact 12-month outcomes. Aim: To compare the clinical and functional characteristics of patients who died within 12 months after revascularized STEMI versus NSTEMI, identifying factors associated with 1-year mortality. Methods: We performed a retrospective observational study of 1,078 revascularized MI patients (528 STEMI, 550 NSTEMI) followed for one year. We identified 176 patients who died within 12 months (95 STEMI and 81 NSTEMI) and analyzed their baseline risk factors, clinical presentation (including Killip class), laboratory findings, echocardiographic parameters (left ventricular ejection fraction - LVEF), and comorbidities. Results: The two groups of deceased patients were similar in age (~70 years). Both had very high prevalence of hypertension (>90%) and a low proportion of active smokers (~12%). NSTEMI decedents more often had diabetes (~55% vs 44%) and hypercholesterolemia (~79% vs 57%) than STEMI decedents. NSTEMI decedents also had more frequently a history of prior MI (~50% vs ~36%), stroke (23% vs 12%), or peripheral arterial disease (16% vs 8%). By contrast, cardiogenic shock at presentation was more common in STEMI decedents (Killip class IV in 27% vs 16%). Severe left ventricular dysfunction (LVEF <30%) was present in about half of the patients in both groups. Acute atrial fibrillation occurred more often in STEMI (30% vs 18%). Conclusions: Within 12 months post-infarction, patients dying after STEMI had more severe acute presentations (more cardiogenic shock and arrhythmias), whereas those dying after NSTEMI had a higher burden of risk factors and comorbidities. Nonetheless, both cohorts exhibited significant left ventricular dysfunction and high complication rates, indicating that both the acute infarct severity and underlying chronic conditions contribute to 1-year mortality after MI.