One-Year Prognostic Differences and Management Strategies between ST-Elevation and Non-ST-Elevation Myocardial Infarction: Insights from the PRAISE Registry.

Matteo Betti, Attilio Lauretti, Francesco Ajmone, Paola Pastena, Nicola Pierucci, Maciej Banach, Alberto Polimeni, Giuseppe Biondi-Zoccai, Fabrizio D'Ascenzo, Francesco Versaci, Pierre Sabouret, Federico Russo, Marco Bernardi, Luigi Spadafora, Stefano Cacciatore, Francesco Fiorentino, Giacomo Frati, Sebastiano Sciarretta, Gaetano Maria De Ferrari, Ovidio De Filippo, Marco Borgi, Giorgia Panichella

Journal: American journal of cardiovascular drugs : drugs, devices, and other interventions 2025;25(5):681-691

PMID: 40555879

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Abstract

INTRODUCTION

Whether ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) carry distinct prognoses after discharge remains a matter of debate. This study aimed to compare 1-year clinical outcomes between patients with STEMI and NSTEMI in a large, real-world cohort.

METHODS

Among 23,270 patients with acute coronary syndrome enrolled in the international PRAISE registry between 2003 and 2019, we included 21,789 patients with a diagnosis of either STEMI or NSTEMI. Clinical characteristics, discharge medications, and outcomes at 1 year were analyzed. The primary outcomes were all-cause mortality, re-infarction, and major bleeding. Multivariable logistic regression and propensity score matching were used to adjust for confounding. Subgroup and interaction analyses were also performed.

RESULTS

The cohort included 12,365 patients with STEMI and 9424 patients with NSTEMI. At baseline, patients with NSTEMI had more comorbidities, cardiovascular risk factors (except diabetes), and prior revascularization. Patients with STEMI were more frequently treated with statins, beta-blockers, and renin-angiotensin-aldosterone system inhibitors at discharge. At 1-year follow-up, overall outcomes were comparable between groups. Nonfatal reinfarction occurred more frequently in patients with NSTEMI (3.4% versus 2.8%, p = 0.022), but this association was not significant after adjustment (odds ratio [OR] 0.90, 95% confidence interval [CI] 0.65-1.24, p = 0.519). Results from propensity score-matched analyses confirmed the absence of prognostic differences. Subgroup analyses revealed significant interactions for diabetes mellitus and completeness of revascularization.

CONCLUSIONS

After accounting for clinical and therapeutic variables, 1-year outcomes were largely similar in patients with STEMI and NSTEMI. Differences in reinfarction risk appear to be driven by baseline characteristics and treatment patterns, rather than infarct type itself.

Address: Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy. [email protected].; UOC UTIC Emodinamica e Cardiologia, Ospedale Santa Maria Goretti, Latina, Italy. [email protected].; Division of Cardiology, Department of Medicine, Stony Brook University, Stony Brook, NY, USA.; Division of Cardiology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA.; Department of Geriatrics, Orthopedics, and Rheumatology, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168, Rome, Italy.; Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy.; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.; Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.; Maria Cecilia Hospital, GVM Care and Research, 48033, Cotignola, Italy.; Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, Turin, Italy.; UOC UTIC Emodinamica e Cardiologia, Ospedale Santa Maria Goretti, Latina, Italy.; Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.; IRCCS NeuroMed, Pozzilli, Italy.; Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.; Department of Clinical Internal Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00161, Rome, Italy.; Heart Institute and Action Group, Pitié-Salpétrière, Sorbonne University, Paris, France.; National College of French Cardiologists, Paris, France.; Department of Clinical and Molecular Medicine, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00199, Rome, Italy.; Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036, Rende, Italy.; Division of Interventional Cardiology, Annunziata Hospital, 87100, Cosenza, Italy.; Department of Preventive Cardiology and Lipidologym, Medical University of Lodz (MUL), Lodz, Poland.; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.; Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.; UOC UTIC Emodinamica e Cardiologia, Ospedale Santa Maria Goretti, Latina, Italy.

DOI: 10.1007/s40256-025-00739-8

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https://dx.doi.org/10.1007/s40256-025-00739-8

MeSH Terms: Humans, Female, Male, ST Elevation Myocardial Infarction, Non-ST Elevated Myocardial Infarction, Registries, Aged, Middle Aged, Prognosis, Propensity Score, Risk Factors, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Adrenergic beta-Antagonists