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Should we improve the management of NSTEMI? Results from the population-based “acute myocardial infarction in Florence 2” (AMI-Florence 2) registry

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Abstract

ST-segment and non-ST-segment elevation myocardial infarction (STEMI, NSTEMI) have opposite epidemiology, the latter being nowadays more common than the former. Consistently with these epidemiological trends, application of evidence-based clinical practice guidelines on the management of NSTEMI should be promoted. We compared clinical features, hospital management and prognosis of STEMI/NSTEMI in an unselected cohort of 1,496 prospectively enrolled patients (STEMI, 36.9 % and NSTEMI, 63.1 %), admitted in 1 year to one of the six hospitals in Florence health district (Italy). Vital status was assessed after 1 year. NSTEMI patients were older, more often female, and affected by cardiovascular and non-cardiovascular comorbidities. Percutaneous coronary intervention (PCI) was performed more often in STEMI (82 %) than in NSTEMI patients (48 %, p < 0.001). Aspirin, clopidogrel, statins, beta-blockers, and ACE-inhibitors were prescribed more frequently in STEMI. In-hospital mortality was significantly lower in NSTEMI than in STEMI (4.2 vs. 8.9 %, p < 0.001), even after adjusting for confounders in a multivariable logistic model (OR 0.27, 95 % CI 0.16–0.45). One-year mortality was similar in NSTEMI and STEMI patients in an unadjusted comparison (18.0 vs. 16.7 %, p = 0.51), but it was lower in NSTEMI patients in multivariable Cox analysis (HR 0.56, 95 % CI 0.42–0.75). PCI reduced the risk of 1-year mortality similarly in STEMI (HR 0.47, 95 % CI 0.28–0.79) and NSTEMI (HR 0.41, 95 % CI 0.28–0.60). PCI reduces mortality in both STEMI and NSTEMI, but it is underutilised in patients with NSTEMI. To improve overall prognosis of AMI, efforts should be made at improving the care of NSTEMI patients.

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Acknowledgments

The authors thank the AMI-FLORENCE WORKING GROUP: Fabrizio Bandini; Elisabetta Betti; Antonietta Fumarulo; Pasquale Petrone; Roberto Tannini; Irene Agostino; Renzo Camajori-Tedeschini; Raffaele Laureano; Cinzia Lusini; Cristina Mugnaini; Alessandro Rosselli; Germana Ruggiano; Luciano Bagnoli; Carlo Cappelletti; Laura Cintelli; Plinio Fabiani; Maurizio Filice; Giancarlo Gianassi; Roberto Gianni; Martina Minelli; Gino Pacenti; Pierluigi Battelli; Simona Spini; Paola Naldoni; Lucia De Vito; Roberto Berni; Rosanna Abbate; Brunetto Alterini; Caterina Baroncini; Gabriele Ciuti; Stefano Del Pace; Cristina Giglioli; Anna Maria Gori; Stefano Grifoni; Caterina Lamanna; Rossella Marcucci; Alessandro Morettini; Carlo Nozzoli; Francesco Orso; Alberto Moggi-Pignone; Loredana Poggesi; Carlo Rostagno; Andrea Sori; Serafina Valente; Paolo Valoti.

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Authors and Affiliations

  1. Epidemiology Unit, Local Health Unit 10 Firenze, Via di San Salvi 12, 50135, Florence, Italy

    Daniela Balzi & Alessandro Barchielli

  2. Unit of Gerontology and Geriatric Medicine, Department of Cardiovascular Medicine, University of Florence and Careggi Hospital, Florence, Italy

    Mauro Di Bari & Niccolò Marchionni

  3. Cardiology Unit, Santa Maria Annunziata Hospital, Local Health Unit 10 Firenze, Florence, Italy

    Piercarlo Ballo

  4. Cardiology Unit 1, Department of Cardiovascular Medicine, Careggi Hospital, Florence, Italy

    Nazario Carrabba

  5. Unit of Internal Medicine and Cardiology, Department of Cardiovascular Medicine, University of Florence and Careggi Hospital, Florence, Italy

    Antonella Cordisco, Serafina Valente & Gian Franco Gensini

  6. Cardiology Unit, Santa Maria Nuova Hospital, Local Health Unit 10 Firenze, Florence, Italy

    Maria Cristina Landini & Alfredo Zuppiroli

  7. Cardiology Unit, Nuovo San Giovanni di Dio Hospital, Local Health Unit 10 Firenze, Florence, Italy

    Giovanni Maria Santoro

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  1. Daniela Balzi
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  2. Mauro Di Bari
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  3. Alessandro Barchielli
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  9. Serafina Valente
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  11. Niccolò Marchionni
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  12. Gian Franco Gensini
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Correspondence to Daniela Balzi.

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AMI-2 Florence working group

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Balzi, D., Di Bari, M., Barchielli, A. et al. Should we improve the management of NSTEMI? Results from the population-based “acute myocardial infarction in Florence 2” (AMI-Florence 2) registry. Intern Emerg Med 8, 725–733 (2013). https://doi.org/10.1007/s11739-012-0817-6

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