Occlusion myocardial infarction without ST-elevation is associated with delayed angiography and a higher risk of cardiovascular events.

Authors

André Lobo, Gonçalo Leal, Francisco Sousa, Francisca Nunes, Marta Catarina Almeida, Francisco Sampaio, Ricardo Fontes-Carvalho

Published in

Cardiovascular revascularization medicine : including molecular interventions. Nov 02, 2026. Epub Nov 02, 2026.

Abstract

ST-segment elevation decides who undergoes immediate angiography, yet a quarter to a third of patients without it have an occlusion myocardial infarction (OMI) and follow the slower non-ST-elevation pathway. Their outcome over extended follow-up compared with ST-elevation myocardial infarction (STEMI), including non-fatal events, is poorly defined.
In a retrospective single-centre cohort, we reclassified 313 consecutive patients with acute coronary syndrome undergoing angiography as STEMI, NSTEMI-OMI, or NSTEMI-non-OMI. OMI was pre-specified as culprit TIMI flow ≤2, and/or markedly elevated peak troponin with a new wall-motion abnormality. The composite of death, recurrent myocardial infarction, or cardiovascular readmission was assessed at 12 months and over a median follow-up of 26.2 months.
Of 313 patients, 177 had STEMI and 136 had no ST-elevation, of whom 54 (39.7%) fulfilled OMI criteria. Median time to angiography was 10.1 h in NSTEMI-OMI versus 1.0 h in STEMI (p < 0.001) and 15.9 h in NSTEMI-non-OMI (p = 0.140). The 12-month composite occurred in 16.7% of NSTEMI-OMI, 3.4% of STEMI, and 2.4% of NSTEMI-non-OMI (p = 0.001). The adjusted hazard ratio for NSTEMI-OMI was 3.46 (95% CI 1.70-7.02) versus STEMI and 3.31 (1.43-7.63) versus NSTEMI-non-OMI. In patients event-free at 12 months, the unadjusted hazard ratio versus STEMI was 3.56 (1.40-9.05).
Patients with OMI but no ST-segment elevation waited longer for angiography than STEMI and had a higher hazard of the composite outcome than both other groups, an excess persisting beyond the first year.

PMID:
42988626
Bibliographic data and abstract were imported from PubMed on 06 Nov 2026.

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