Features of changes in cumulative survival of patients with acute coronary syndrome presenting without elevation of ST segment, who underwent percutaneous coronary interventions at various periods from the onset of symptoms

Main Article Content

M. Yu. Sokolov
Yu. V. Kashuba
S. O. Chaychuk


The aim – to evaluate the effect of myocardial revascularization performed on patients with acute coronary syndrome without persistent ST-segment elevation (NSTE-AMI) at different times from the onset of symptoms, on ultrasound of left ventricular contractility (LV) and on the functional class of angina after 12 months of follow-up of these patients.
Materials and methods. Patients with acute myocardial infarction (AMI) without persistent ST-segment elevation (NSTEMI) enrolled in the study (n=128) were divided into groups according to the time of revascularization (urgent or planned revascularization) and the method of revascularization (coronary stenting or shunting) on 5 groups, including the group of NSTEMI patients who did not undergo stenting. Group 1 consisted of patients (n=28) who underwent urgent coronary angiography and ad hoc stenting in the first 72 hours after the onset of symptoms. Group 2 included patients (n=61) who underwent coronary angiography and stenting routinely after 72 hours or more (up to several months of onset of symptoms). Group 3 included patients (n=12) who underwent routine coronary artery bypass grafting. Group 4 consisted of patients (n=27) who did not undergo revascularization after coronary angiography («control group»). And, finally, the 5th group, which consisted of patients of the above groups (n=101), who underwent any revascularization.
Results and discussion. The effectiveness of treatment and the incidence of serious coronary events in NSTEMI patients significantly depend on the availability of percutaneous and surgical revascularization techniques in the treatment program. Supplementation of the revascularization procedure significantly improves the prognosis, significantly reduces the combined rate of MACE during the observation period of patients (up to 48 months) compared with the control group (p=0.000001).
A direct comparison of the group of urgent coronary stenting (within 72 hours from the onset of symptoms) of NSTEMI patients with GRACE Score > 140 points, revealed a significant difference in the number of serious cardiovascular events at 48 months of follow-up (p<0.05), compared with the control group GRACE Score > 140.
Conclusions. Long-term stenting results of NSTEMI patients at high risk of complications (emergency stenting group) did not take precedence over the results of treatment of stable NSTEMI patients (planned stenting group) after their effective stabilization on the background of optimal drug therapy. When comparing the MACE of these two groups, a weakly significant advantage (p<0.05) was found in the group of stabilized patients, which fully confirms the strategy of stratification of patients with unstable coronary blood flow to groups at risk of complications. However, urgent interventions are absolutely indicated for patients at high risk of complications in the first days after the onset of destabilization symptoms.

Article Details


acute coronary syndrome without ST segment elevation, coronary angiography, coronary stenting, cumulative survival, GRACE Score


Badings EA, Dambrink JH, van Wijngaarden J, et al. Early or late intervention in high-risk non-ST-elevation acute coronary syndromes: results of the ELISA-3 trial. Euro Intervention. 2013; 9:54–61. https://pubmed.ncbi.nlm.nih.gov/23685295/

Mehta SR, Granger CB, Boden WE, et al. TIMACS Investigators. Early versus delayed invasive intervention in acute coronary syndromes. N Engl J Med. 2009;360:2165–75. https://www.nejm.org/doi/full/10.1056/nejmoa0807986

Badimon L, Padro T, Vilahur G. Atherosclerosis, platelets and thrombosis in acute ischaemic heart disease. Eur Heart J Acute Cardiovasc Care. 2012;1:60–74. https://academic.oup.com/ehjacc/article/1/1/60/5921856

Collet J-P, Thiele H, Barbato E, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021;42(14):1289–1367. doi: 10.1093/eurheartj/ehaa575. https://academic.oup.com/eurheartj/article/42/14/1289/5898842

Fokkema ML, James SK, Albertsson P, et al. Population trends in percutaneous coronary intervention: 20-year results from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry). J Am Coll Cardiol. 2013;61(12):1222–30. https://www.sciencedirect.com/science/article/pii/S0735109713002544?via%3Dihub

Gale CP, Allan V, Cattle BA, et al. Trends in hospital treatments, including revascularisation, following acute myocardial infarction, 2003–2010: a multilevel and relative survival analysis for the National Institute for Cardiovascular Outcomes Research (NICOR). Heart. 2014;100(7):582–9. https://heart.bmj.com/content/100/7/582.full

Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39:119–77. https://academic.oup.com/eurheartj/article/39/2/119/4095042

Jernberg T. Swedeheart Annual Report 2015. In: Karolinska University Hospital, Huddinge, 14186 Stockholm; 2016. https://heart.bmj.com/content/96/20/1617

Khera S, Kolte D, Gupta T, et al. Temporal trends and sex differences in revascularization and outcomes of st-segment elevation myocardial infarction in younger adults in the United States. J Am Coll Cardiol. 2015;66(18):1961–72. https://www.sciencedirect.com/science/article/pii/S0735109715059690?via%3Dihub

Kristensen SD, Fajadet J, Sokolov M, et al. Reperfusion therapy for ST elevation acute myocardial infarction 2010/2011: current status in 37 ESC countries. Eur Heart J. 2014;35: 1957–70. doi:10.1093/eurheartj/eht529. https://academic.oup.com/eurheartj/article/35/29/1957/540991

Marino P, Zanolla L, Zardini P (GISSI). Effect of streptokinase on left ventricular modeling and function after myocardial infarction: the GISSI trial. J Am Coll Cardiol. 1989;14:1149–58. https://www.sciencedirect.com/science/article/pii/0735109789904099?via%3Dihub

McManus DD, Gore J, Yarzebski J, et al. Recent trends in the incidence, treatment, and outcomes of patients with STEMI and NSTEMI. Am J Med. 2011;124(1):40–7. https://www.sciencedirect.com/science/article/abs/pii/S0002934310007369

Mehta SR, Cannon CP, Fox KA, et al. Routine vs selective invasive strategies in patients with acute coronary syndromes: a collaborative meta-analysis of randomized trials. JAMA. 2005;293:2908–17. https://jamanetwork.com/journals/jama/article-abstract/201087

Milosevic A, Vasiljevic-Pokrajcic Z, Milasinovic D, et al. Immediate versus delayed invasive intervention for non-STEMI patients: the RIDDLE-NSTEMI study. JACC Cardiovasc Interv. 2016;9:541–9. https://www.sciencedirect.com/science/article/pii/S1936879815017549?via%3Dihub

Montalescot G, Cayla G, Collet JP, et al. ABOARD Investigators. Immediate vs delayed intervention for acute coronary syndromes: a randomized clinical trial. JAMA. 2009;302:947–54. https://jamanetwork.com/journals/jama/fullarticle/184504

Mozaffarian D, Benjamin EJ, Go AS, et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics — 2015 update: a report from the American Heart Association. Circulation. 2015;131(4):e29–322. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000152

Neumann FJ, Kastrati A, Pogatsa-Murray G, et al. Evaluation of prolonged antithrombotic pretreatment (“cooling-off” strategy) before intervention in patients with unstable coronary syndromes: a randomized controlled trial. JAMA. 2003; 290:1593–9. https://jamanetwork.com/journals/jama/fullarticle/197347

Pedersen F, Butrymovich V, Kelbaek H, et al. Short- and long-term cause of death in patients treated with primary PCI for STEMI. J Am Coll Cardiol. 2014;64(20):2101–8. https://www.sciencedirect.com/science/article/pii/S0735109714061956?via%3Dihub

Puymirat E, Simon T, Steg PG, et al. USIK USIC 2000 Investigators, FAST MI Investigators. Association of changes in clinical characteristics and management with improvement in survival among patients with ST-elevation myocardial infarction. JAMA. 2012;308(10):998–1006. https://jamanetwork.com/journals/jama/fullarticle/1355142

Roffi M, Patrono C, Collet JP, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37:267–315. https://academic.oup.com/eurheartj/article/37/3/267/2466099

Sugiyama T, Hasegawa K, Kobayashi Y, et al. Differential time trends of outcomes and costs of care for acute myocardial infarction hospitalizations by ST elevation and type of intervention in the United States, 2001–2011. J Am Heart Assoc. 2015;4(3):e001445. https://www.ahajournals.org/doi/10.1161/JAHA.114.001445

Terkelsen CJ, Lassen JF, Norgaard BL, et al. Mortality rates in patients with ST-elevation vs. non-ST-elevation acute myocardial infarction: observations from an unselected cohort. Eur Heart J. 2005;26:18–26. https://academic.oup.com/eurheartj/article/26/1/18/494614

Thiele H, Rach J, Klein N, et al. LIPSIA-NSTEMI Trial Group. Optimal timing of invasive angiography in stable non-ST-elevation myocardial infarction: the Leipzig Immediate versus early and late Percutaneous Coronary Intervention Trial in NSTEMI (LIPSIA-NSTEMI trial). Eur Heart J. 2012;33:2035–43. https://pubmed.ncbi.nlm.nih.gov/22108830/

Touchstone DA, Beller GA, Nygaard TW, et al. Effects of successful intravenous reperfusion therapy on regional myocardial function and geometry in humans: a topographic assessment using two-dimensional echocardiography. J Am Coll Cardiol. 1989;13:1506–13. https://www.sciencedirect.com/science/article/pii/0735109789903409?via%3Dihub

Townsend N, Wilson L, Bhatnagar P, et al. Cardiovascular disease in Europe: epidemiological update 2016. Eur Heart J. 2016;37(42):3232–45. https://academic.oup.com/eurheartj/article/37/42/3232/2536403

Warren SE, Royal HD, Markis JE, et al. Time course of left ventricular dilation after myocardial infarction: influence of infarct-related artery and success of coronary thrombolysis. J Am Coll Cardiol. 1988;11:12–9. https://www.sciencedirect.com/science/article/pii/0735109788901593?via%3Dihub

White HD, Cross DB, Elliott JM, et al. Long-term prognostic importance of patency of the infarct-related coronary artery after thrombolytic therapy for acute myocardial infarction. Circulation. 1994;89:61–7. https://www.ahajournals.org/doi/10.1161/01.CIR.89.1.61

Widimsky P, Wijns W, Fajadet J, et al. European Association for Percutaneous Cardiovascular Interventions. Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries. Eur Heart J. 2010;31(8):943–57. https://academic.oup.com/eurheartj/article/31/8/943/544540

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