584 Acute cardiac care (NSTEMI) are heterogeneous and carry differences in prognosis. The presence of total occlusion of infarct related artery (TO-IRA) at coronary angiography likely shares the same pathophysiology as myocardial infarction with ST elevation (STEMI) and may signal higher risk. Purpose: Our aim was to compare in-hospital mortality (IHM) in pts with STEMI and NSTEMI, with or without TO-IRA. Methods: We analyzed 12 107 consecutive ACS pts, enrolled in a multicenter national

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... y between October 2010 and September 2016. Three groups were considered according to baseline diagnosis and coronary angiography findings: A -STEMI (n=6165; 50.9%), B -NSTEMI with (n=919; 7.6%) and C -NSTEMI without (n=5023; 41.5%) TO-IRA. The predictors of the endpoint IHM were assessed by univariate and multivariable analysis through logistic regression model. Results : There were differences between groups A, B and C in age (64±14 vs. 63±12 vs. 66±12, p<0.001), cardiovascular (CV) risk factors [hypertension (61.2% vs. 68.7% vs. 74.2%, p<0.001), diabetes (24.1% vs. 28.4% vs. 34.5%, p<0.001) and dyslipidaemia (51.3% vs. 64.4% vs. 61.6%, p<0.001)] and prior CV events [myocardial infarction (10.6% vs. 20.9% vs. 22.4%, p<0.001) and stroke / TIA (6.3% vs. 7.9% vs. 8.0%, p=0.002)]. The severity of the clinical presentation was also distinct, considering Killip-Kimball (KK) class [KK > I (14.5% vs. 11.3% vs. 13.6%, p=0.021)] and GRACE score (161±39 vs. 133±37 vs. 137±38, p<0.001). Percutaneous revascularization was performed at different rates (85.7% vs. 69.3% vs. 61.0%, p<0.001). The culprit lesion was located in left anterior descending artery more frequently in group A (44.8% vs. 28.4% vs. 31.3%, p<0.001) and in the left circumflex artery in group B (12.4% vs. 45.8% vs. 8.2%, p<0.001). The endpoint was more frequently reached in group A, followed by group B (5.5% vs. 1.5% vs. 0.8%, p<0.001). Logistic regression analysis is shown in figure. Conclusions: NSTEMI with TO-IRA pts have a less severe clinical presentation (represented by KK class and GRACE score) when compared with STEMI pts, reaching lower IHM rates. However after adjust for confounders NSTEMI with TO-IRA pts achieve similar IHM risk than STEMI pts, potentially explained by lower rates of myocardial revascularization in NSTEMI with TO-IRA. Between NSTEMI pts, a higher CV risk profile is seen in NSTEMI without TO-IRA pts (older, higher rates of CV risk factors and prior CV events); despite this they have the lowest probability of dying in-hospital.