Complications in Patients with STEMI versus Non-STEMI: A Clinical Comparison

Dan Pasaroiu; Imre Benedek; Adriana Blendea; Teodora Popa; Constantin Tolescu; Monica Chitu; Theodora Benedek

doi:10.2478/jce-2025-0014

.blurhash-client-img { display: none !important; }

Complications in Patients with STEMI versus Non-STEMI: A Clinical Comparison

Journal of Cardiovascular Emergencies

Volume 12 (2026): Issue 2 (June 2026)

By: Dan Pasaroiu, Imre Benedek, Adriana Blendea, Teodora Popa, Constantin Tolescu, Monica Chitu and Theodora Benedek

Open Access

|Jun 2026

Abstract

Background

Acute coronary syndrome (ACS) includes ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI), each with distinct clinical profiles and outcomes. While STEMI is typically associated with more extensive infarcts, emerging data suggest NSTEMI may carry a greater burden of comorbidities and anatomical complexity.

Objective

To compare the incidence of ventricular arrhythmias and hemodynamic instability in patients with STEMI vs. NSTEMI and to analyze the distribution of culprit coronary lesions. Methods: This retrospective single-center study included 172 patients who underwent coronary revascularization between April and July 2021. Clinical outcomes, arrhythmias, and hemodynamic instability were compared between groups with STEMI (n = 108) and NSTEMI (n = 64). Culprit lesions were evaluated by angiography and categorized by vessel.

Results

Hemodynamic instability was significantly more common in patients with NSTEMI (10.93%) compared to STEMI (0.18%) (p = 0.005). Ventricular arrhythmias occurred in 12.03% of patients with STEMI and 7.81% of patients with NSTEMI, with no significant difference. Left main coronary artery lesions were notably more frequent in NSTEMI (47.4% vs. 2.04%; p < 0.0001), whereas right coronary artery involvement was higher in STEMI (40.81% vs. 7.4%; p < 0.0001). Ventricular arrhythmias were significantly associated with circumflex artery lesions in patients with NSTEMI (p = 0.0001).

Conclusions

Despite often being perceived as lower risk, patients with NSTEMI exhibited a higher rate of hemodynamic instability and more complex coronary involvement, particularly left main disease. These findings highlight the need for vigilant monitoring and individualized treatment strategies in populations with NSTEMI.

References

Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Circulation. 2012;126(16):2020-2035. doi: 10.1161/CIR.0b013e31826e1058
Open DOI Search in Google Scholar Back to article
Halațiu V-B, Benedek I, Rodean I-P, et al. Coronary Computed Tomography Angiography-Derived Modified Duke Index Is Associated with Peri-Coronary Fat Attenuation Index and Predicts Severity of Coronary Inflammation. Medicina. 2024; 60(5):765. doi: 10.3390/medicina60050765
Open DOI Search in Google Scholar Back to article
Ammann P, Fehr T, Minder EI, et al. Elevation of cardiac troponin I in sepsis and septic shock. Intensive Care Med. 2001;27(6):965-969. doi: 10.1007/s001340100920
Open DOI Search in Google Scholar Back to article
Wang K, Asinger RW, Marriott HJL. ST-segment elevation in conditions other than acute myocardial infarction. N Engl J Med. 2003;349(22):2128-2135. doi: 10.1056/NEJMra022580
Open DOI Search in Google Scholar Back to article
Reynolds HR, Hochman JS. Cardiogenic shock: current concepts and improving outcomes. Circulation. 2008;117(5):686-697. doi: 10.1161/CIRCULATIONAHA.106.613596
Open DOI Search in Google Scholar Back to article
Thiele H, Ohman EM, de Waha-Thiele S, et al. Management of cardiogenic shock complicating myocardial infarction: An update 2019. Eur Heart J. 2019;40(32):2671-2683. doi: 10.1093/eurheartj/ehz363
Open DOI Search in Google Scholar Back to article
Jeger RV, Radovanovic D, Hunziker PR, et al. Ten-year trends in the incidence and treatment of cardiogenic shock. Ann Intern Med. 2008;149(9):618-626. doi: 10.7326/0003-4819-149-9-200811040-00005
Open DOI Search in Google Scholar Back to article
Babaev A, Frederick PD, Pasta DJ, et al. Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock. JAMA. 2005;294(4):448-454. doi: 10.1001/jama.294.4.448
Open DOI Search in Google Scholar Back to article
Sánchez-Salado JC, Burgos V, Ariza-Solé A, et al. Trends in cardiogenic shock management and prognostic impact of type of treating center. Rev Esp Cardiol (Engl Ed). 2020 Jul;73(7):546-553. doi: 10.1016/j.rec.2019.10.004
Open DOI Search in Google Scholar Back to article
Hochman JS, Sleeper LA, Webb JG, et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. N Engl J Med. 1999;341(9):625-634. doi: 10.1056/NEJM199908263410901
Open DOI Search in Google Scholar Back to article
Van Diepen S, Katz JN, Albert NM, et al. Contemporary management of cardiogenic shock: A scientific statement from the American Heart Association. Circulation. 2017;136(16):e232-e268. doi: 10.1161/CIR.0000000000000525
Open DOI Search in Google Scholar Back to article
Alqahtani, F, Ziada, K, Badhwar, V. et al. Incidence, Predictors, and Outcomes of In-Hospital Percutaneous Coronary Intervention Following Coronary Artery Bypass Grafting. JACC. 2019 Feb 5;73(4):415-423. doi: 10.1016/j.jacc.2018.10.071
Open DOI Search in Google Scholar Back to article
Czinege MG, Nyulas V, Halațiu VB, et al. Interrelationship between Altered Left Ventricular Ejection Fraction and Nutritional Status in the Post-Acute Myocardial Infarction Patient. Nutrients. 2024; 16(13):2142. doi: 10.3390/nu16132142
Open DOI Search in Google Scholar Back to article
Fox KA, Carruthers KF, Dunbar DR, et al. Underestimated and under-recognized: the late consequences of acute coronary syndrome (GRACE UK-Belgian Study). Eur Heart J. 2010;31(22):2755-2764. doi: 10.1093/eurheartj/ehq326
Open DOI Search in Google Scholar Back to article
Zeymer U, Alushi B, Noc M, et al. Influence of Culprit Lesion Intervention on Outcomes in Infarct-Related Cardiogenic Shock With Cardiac Arrest. J Am Coll Cardiol. 2023;81(12):1165-1176. doi: 10.1016/j.jacc.2023.01.029
Open DOI Search in Google Scholar Back to article
Demidova MM, Rylance R, Koul S, et al. Prognostic value of early sustained ventricular arrhythmias in ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: A substudy of VALIDATE-SWEDEHEART trial. Heart Rhythm O2. 2022 Dec 22;4(3):200-206. doi: 10.1016/j.hroo.2022.12.008
Open DOI Search in Google Scholar Back to article

Articles in this issue

DOI: https://doi.org/10.2478/jce-2025-0014 | Journal eISSN: 2457-5518 | Journal ISSN: 2457-550X

Journal RSS Feed

Language: English

Page range: 61 - 67

Submitted on: Feb 4, 2025

Accepted on: Jul 20, 2025

Published on: Jun 24, 2026

Published by: Asociatia Transilvana de Terapie Transvasculara si Transplant KARDIOMED

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

STEMI,

NSTEMI,

hemodynamic instability,

ventricular arrhythmias,

coronary artery disease

Related subjects:

Emergency medicine and intensive-care medicine,

Radiology

© 2026 Dan Pasaroiu, Imre Benedek, Adriana Blendea, Teodora Popa, Constantin Tolescu, Monica Chitu, Theodora Benedek, published by Asociatia Transilvana de Terapie Transvasculara si Transplant KARDIOMED
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Volume 12 (2026): Issue 2 (June 2026)