Background: Non—ST-segment elevation myocardial infarction (NSTEMI) comprises the majority of MI worldwide, yet mortality remains high. Management of NSTEMI is relatively delayed and heterogeneous compared with the “time is muscle” approach to ST-segment elevation MI, though it is unknown to what extent comorbid conditions drive NSTEMI mortality.

Objectives: We sought to quantify mortality due to MI versus comorbid conditions in patients with NSTEMI.

Methods: Participants of the ARIC (Atherosclerosis Risk in Communities) study cohort ages 45 to 64 years, who developed incident NSTEMI were identified and incidence-density matched to participants who did not experience an MI by age group, sex, race, and study community. We estimated hazard ratios for all-cause mortality, comparing those who developed NSTEMI to those who did not experience an MI.

Results: ARIC participants with incident NSTEMI were more likely at baseline to be smokers, have diabetes and renal dysfunction, and take blood pressure or cholesterol-lowering medications than were participants who did not have an MI. Over one-half of participants experiencing NSTEMI died over a median follow-up of 8.4 years; incident NSTEMI was associated with 30% higher risk of mortality after adjusting for comorbid conditions (hazard ratio: 1.30; 95% confidence interval: 1.11 to 1.53).

Conclusions: NSTEMI confers a significantly higher mortality hazard beyond what can be attributed to comorbid conditions. More consistent and effective strategies are needed to reduce mortality in NSTEMI amid comorbid conditions.

Highlights

• This is the first study which uses long-term follow-up data of a clinical national dataset (ARIC) to find hazards of mortality conferred by NSTEMI event after controlling for a majority of comorbid conditions.
• NSTEMI confers a 30% higher risk of mortality beyond what can be attributed to comorbid conditions.
• Recognition that the myocardial injury event itself contributes to excess risk of subsequent death should motivate strategies that limit myocardial damage in patients with NSTEMI similar to management of STEMI.