Differences of the Treatment of Acute NSTEMI and STEMI

Objective: To evaluate major adverse clinical outcomes in patient with ST-elevation myocardial infarction (STEMI) or Non-ST-elevation myocardial infarction (NSTEMI) requiring urgent coronary artery bypass graft (CABG).

Methods: Between 2010 and 2017, a total number of 903 patients were included into a prospective infarct registry. Demographic data, intraoperative variables and postoperative clinical outcomes were compared between NSTEMI and STEMI.

Results: From 903 patients 613 (67.9%) showed up with NSTEMI and 290 (32.1%) patients with STEMI. NSTEMI patients were older (68.1 versus 64.7 years, p < 0.0001) had a higher BMI (28.4 versus 27.2, p < 0.05) had more cardiovascular risk factors like diabetes (36.4% versus 23.1%, p < 0.0001), arterial Hypertension (85.3% versus 75.8%, p < 0.05), hyperlipoproteinemia (46.8% versus 39.7% p < 0.05) and suffered more likely from chronic obstructive pulmonary diseases (12.6% versus 9.3%, p < 0.05) and peripheral arterial diseases (14.5% versus 9.3%, p < 0.05) when compared with STEMI patients. STEMI patients had a higher rate for preoperative cardiac resuscitation (20.3% versus 1.7%, p < 0.0001) underwent more often a percutaneous intervention within 6 hours before transferring to our department (22.5% versus 5.2%, p < 0.0001) and suffered from left main stenosis (39.3% versus 29.3%, p < 0.05) in comparison to NSTEMI patients. NSTEMI patients were staffed with more arterial grafts (1.1% versus 0.9%, p < 0.05). Thus, STEMI patients had a higher count of incomplete revascularization (8.97% versus 5.87%, p < 0.05). Apart from these factors the other intraoperative variables did not differ between groups. Major postoperative cardiac events (MACE) were higher in the STEMI group with a higher rate of low cardiac output syndrome (21.0% versus 7.5%, p < 0.0001) the other MACE like stroke and reinfarction did not differ. The mortality rate of the NSTEMI patients was 6.69%. In contrast, in-hospital mortality was 15.9% in the STEMI group. STEMI patients required longer time to taper catecholamine therapy (19.3% versus 13.7%, p < 0.05) had longer intubation times (178.2 versus 51.1 hours, p < 0.0001) and stayed longer at our intensive care unit before relocating to the general ward (6.9 versus 4.9 days, p < 0.0001) compared with NSTEMI patients.

Conclusion: Patients with NSTEMI or STEMI remain a high-risk cohort. We were able to present the pre-, intra- and postoperative differences in STEMI and NSTEMI patient.