Abstract 18753: ST Elevation Myocardial Infarction in Hospitalized Patients is Associated with Delayed Recognition, Low Rate of Early Revascularization and High Mortality
Background ---- Efforts to improve the management of ST segment elevation myocardial infarction (STEMI) have focused on patients whose symptoms begin outside of the hospital. Relatively little is known about STEMI that occurs in patients hospitalized for another condition.
Methods ---- In-patient STEMI at a university hospital with primary percutaneous coronary intervention (PCI) center were identified by searching the Discharge Database and Cardiac Catheterization Laboratory Database. The diagnosis of STEMI was confirmed by two cardiologists. Non-normally distributed data are presented as median [25%,75%]. Comparison between groups was done using Mann-Whitney rank sum test for continuous variables and χ2 for categorical variables.
Results - A total of 48 in-patient STEMI cases were identified from 139,410 adult discharges from 2007 to 2011. In comparison with 184 out-patient STEMIs who presented directly to the same hospital during the same time span, in-patient STEMI patients were older (69 ± 13 vs 60 ± 13 years; p < 0.01) and more often female (50% vs 33%; p < 0.01). Symptoms were the reason for the index ECG more often in outpatient STEMIs (99% vs 33%; p < 0.01); for in-patient STEMIs a change in clinical status (60%) and/or changes on telemetry (7%) also precipitated an ECG. The median time between the onset of symptoms or change in clinical status to ECG for in-patient STEMI was much greater than door to ECG time for outpatient STEMI (30 [10, 600] vs 5 [2, 10] minutes; p < 0.001). Coronary angiography (71% vs 97%; p < 0.01) and PCI (56% vs 95%; p < 0.01) were performed less frequently in in-patient STEMI. The median ECG to angiography time (91 [45,197] vs. 34 [24,47] minutes; p < 0.001) and the ECG to first device activation (129 [65,250] vs. 51 [40,70] minutes; p < 0.001) were longer with in-patient STEMI. The in-hospital mortality for the in-patient STEMI group was 39.6% but revascularization within 3 hours from the onset of STEMI related event was associated with lower in-hospital mortality compared to patients who had delayed or no revascularization (15% vs 50%; p = 0.02).
Conclusion ---- In-hospital STEMI is associated with atypical clinical presentation, delayed ECG interpretation, low rate of rapid revascularization and high mortality.
- © 2012 by American Heart Association, Inc.