Abstract 10605: Reperfusion Times and In-Hospital Outcomes Among Patients With an Isolated Posterior Myocardial Infarction: Insights From the NCDR®
Background: Isolated posterior myocardial infarction (PMI) is associated with significant morbidity and mortality. Previous research has suggested that difficulty in the timely recognition of this diagnosis may delay reperfusion.
Objective: We hypothesized that subjects diagnosed with a PMI have longer revascularization times and increased mortality when compared to those with an alternative ST-elevation myocardial infarction (STEMI).
Methods: Clinical characteristics and reperfusion times were compared between those with a PMI and those with a non-PMI STEMI in the NCDR ACTION Registry®-GWTG™ from 2007 - 2012. Logistic generalized estimating equations were used to examine risk-adjusted mortality.
Results: Among 117,739 subjects with a STEMI, 824 (0.7%) had an isolated PMI. Compared to those with a non-PMI STEMI, patients with a PMI were more likely to present with cardiac arrest, cardiogenic shock and congestive heart failure (Table ). The median time from arrival ECG to revascularization with percutaneous coronary intervention was longer among subjects with a PMI resulting in fewer patients achieving a door to balloon time within the guideline recommend 90 minutes. Similarly, the median time from arrival ECG to systemic thrombolysis was longer among subjects with a PMI resulting in fewer patients achieving reperfusion within the guideline recommended 30 minutes. Unadjusted in-hospital mortality was greater for those with a PMI compared to those with a non-PMI (OR: 1.76, 95% CI: 1.40 - 2.21), a finding that did not reach statistical significance after multivariable adjustment (AOR: 1.11, 95% CI: 0.83 - 1.50).
Conclusion: Isolated PMI is associated with prolonged times to revascularization and higher unadjusted in-hospital mortality. Increased awareness and recognition of PMI is needed to improve reperfusion times among this subpopulation with STEMI.
- © 2013 by American Heart Association, Inc.