Abstract 12806: Under the Radar: Deaths From ST-Elevation Myocardial Infarction That Do Not Appear in Registries
Background: Medico-administrative data provides information on patients hospitalized with acute ST-elevation myocardial infarction (STEMI). However, patients who present to hospital emergency departments (ED) with STEMI but die before they can be formally admitted tend not to appear in medico-administrative databases or in clinical registries in general.
Methods: We conducted a field evaluation of patients formally admitted with STEMI in Quebec over a 6-month period in 2008-9 in 82 hospitals that treat over 95% of all patients hospitalized with acute myocardial infarction. In these hospitals during the same period, we also identified all deaths of non-admitted patients who had a core-laboratory confirmed STEMI on their presenting electrocardiogram.
Results: There were 1856 patients with STEMI, 1803 (97.1%) patients who were formally admitted and 53 (2.9%) patients who died after reaching the ED but before they could be formally admitted. Of the 1803 admitted STEMI patients, 141 (7.8%) died in-hospital. The addition of the 53 non-admitted deaths raised STEMI mortality to 10.5%, a 35% relative increase, and an absolute contribution to total STEMI death of 27%. Non-admitted patients who died were aged 71±15 years and 34% were women compared with admitted patients who died, aged 77±13 years (p=0.02) of whom 47% were women (p=0.1). Arrival by ambulance was similarly high for admitted and non-admitted patients who died (84% and 93%, respectively, p=0.14). Heart rate and blood pressure at ED triage were not significantly different in the 2 groups. Non-admitted patients died at a median 0.8 hours (10-90 percentile: 0.4-4.5) from ED arrival compared with 61 hours (4.2-361.5) for admitted patients. Rates of fibrinolysis, primary angioplasty, and no reperfusion therapy in non-admitted patients who died were 17%, 4%, and 79%, respectively, compared with 13%, 50%, and 37% in admitted patients who died (p<0.0001).
Conclusions: Non-admitted patients who die comprise a substantial and under-appreciated proportion of STEMI deaths. The rapid occurrence of death in this subset makes any effective intervention very challenging.
- © 2011 by American Heart Association, Inc.