Abstract 17693: National Trends in Case Fatality based on Anatomical Location of ST elevation Myocardial Infarction in Hospitalized Patients, 1993-2009
Introduction: Although mortality due to ST elevation myocardial infarction (STEMI) has declined in the past few decades, it is unknown if this decline is uniform across anatomical locations of STEMI.
Methods: We examined temporal trends in STEMI case fatality related to anatomical location for United States from 1993 to 2009 using Nationwide Inpatient Sample (NIS), a weighted sample dataset that comprises almost 95 % of total discharges from US hospitals. In our study, we included all patients with first hospitalized STEMI with location specified based on ICD-9-CM (410.01- anterolateral, 410.11- anterior, 410.21 - inferolateral, 410.31- inferoposterior, 410.41-inferior, 410.51-lateral and 410.61- inferobasal). We estimated annual percent change using Joinpoint Regression Program (v 3.5, National Cancer Institute, Bethesda, Maryland) assuming Poisson regression.
Results: From 1993 to 2009, 449033 deaths were reported out of 5011979 admissions for STEMI. The overall estimated annual percentage change (EAPC) in case fatality was -2.9 (95 % confidence interval [CI] -3.2 to -2.6). EAPC in STEMI case fatality was -3 (95 % CI -3.5 to -2.5) for admissions with anterolateral, -3.3 (95 % CI -3.7 to -2.9) for anterior, -2.8 (95 % CI -3.3 to -2.3) for inferolateral, -2.4 (95 % CI -3.2 to -1.6) for inferoposterior, -2.7 (95 % CI -2.9 to -2.4) for inferior, -2.1 (95 % CI -2.8 to -1.5) for lateral and 0 (95 % CI -1 to 1.1) for inferobasal. Decline in STEMI case fatality was significant at p < 0.05 for all locations, except for inferobasal location.
Conclusion: Our findings indicate that in-hospital case fatality after initial presentation with inferobasal STEMI continues to remain high despite decline in overall STEMI case fatality in other locations. Unfavorable fatality trends in inferobasal STEMI warrants further investigation.
- © 2012 by American Heart Association, Inc.