Abstract 5102: Patients Developing STEMI In-hospital Have Delayed Reperfusion and Increased 1-year Mortality Compared to STEMI Patients Presenting to the Emergency Department
BACKGROUND: Despite recent advances in ST-elevation myocardial infarction (STEMI) systems of care, there has been little focus on patients who develop STEMI in-hospital. We hypothesized that inpatients who develop STEMI receive less timely care and have worse clinical outcome compared to patients who present to the emergency department (ED) with STEMI.
METHODS: One hundred and twenty-six consecutive cases of STEMI treated with primary percutaneous coronary intervention (PCI) from May 2004 to May 2009 were included in the analysis. A retrospective medical record review was utilized to identify ECG to balloon times, intraaortic balloon pump (IABP) utilization, pre-discharge left ventricular ejection fraction, and duration of hospital stay following STEMI. In-hospital, 30-day, and 1-year mortality data was collected using the National Death Registry.
RESULTS: Twenty-nine inpatients and 97 ED patients diagnosed with STEMI and undergoing PCI were included in this analysis. ECG to balloon time (357±419 min vs 163±188 min, p <0.001), one-year mortality (24.1% vs 5%, p <0.006), and duration of hospital stay (9±12.6 d vs 4.1±4.5 d, p <0.001) were significantly increased in inpatients compared to patients admitted through the ED. Inpatients trended toward increased need for IABP (28% vs. 14.4%, p =0.09) and increased 30-day mortality (13.8% vs 5%, p=0.12). There were no differences in LVEF (45% vs 50%, p=0.22) or in-hospital mortality (10% vs 5%, p=0.27) between the two cohorts.
CONCLUSION: Inpatients who develop STEMI have delayed reperfusion, increased length of stay, and greater 1-year mortality compared to STEMI patients admitted through the ED. Further study is needed to determine if improved identification and more rapid PCI could improve the clinical outcome of patients who develop STEMI in-hospital.