(140) Association Between Mortality and Acute Myocardial Infarction With and Without ST Elevation

Introduction: ST-elevation (STE) is the mainstay for risk stratifying mortality in patients with acute myocardial infarction (AMI). However, STE itself does not correlate well with angiographically defined totally occluded coronary arteries (TOCA). We aimed to compare survival times between AMI patients with and without STE and angiographically defined TOCA.

Methods: Secondary analysis of prospectively enrolled AMI patients undergoing coronary angiography between 2013 and 2020. TOCA was defined as a culprit coronary artery with thrombolysis in myocardial infarction (TIMI) flow grade 0-1, or TIMI flow grade 2 with severe coronary artery narrowing (>70%) and peak 4th-generation troponin 5-10 ng/mL. Qualitative labeling created the following groups: STE-TOCA, non-STE (NSTE)-TOCA, and non-TOCA. Any cause mortality was defined using data from the CDC National Death Index database. Patient characteristics between groups were compared using chi-square, and mean survival time was analyzed with a Kaplan-Meier curve and Cox regression to generate a Hazard Ratio (HR).

Results: Among 611 patients, 61% were male, and 35%, 12%, and 53% had STE-TOCA, NSTE-TOCA, and non-TOCA, respectively. Compared to STE-TOCA, those with NSTE-TOCA and non-TOCA were older (mean ages 63 vs. 65 and 67 years) and had higher rates of hypertension, diabetes, dyslipidemia, heart failure, coronary artery disease, percutaneous coronary intervention, and coronary artery bypass grafting (all p <.05). Further, previous AMI and angina rates were higher for non-TOCA vs. STE-TOCA (p <.001). The sample mean survival time was 5.7 years (CI 5.5-6.0). The mean survival time for STE-TOCA was 6.2 years (CI 5.9-6.6), NSTE-TOCA 5.1 years (CI 4.4-5.8), and non-TOCA 5.5 years (CI 5.2-5.8). There was a significant difference in mean survival time between STE-TOCA and NSTE-TOCA (X^2 13.481 (2), p 0.001). Importantly, NSTE-TOCA was positively associated with hazard of death (HR 2.3 [CI 1.4-3.8], p 0.001) compared to STE-TOCA.

Conclusions: NSTE-TOCA patients are vulnerable and have high morbidity and mortality, which is imperative to acknowledge for clinical decision making. Some NSTE-TOCA patients may benefit from the same timely revascularization that STE-TOCA patients receive. These considerations could have major clinical practice implications not yet realized.