Abstract 13054: STEMI Occurring in Hospitalized Patients is Associated with Less Aggressive Care and Higher Mortality than Outpatient STEMI
Background: Treatment of ST elevation myocardial infarction (STEMI) has improved with the advent of STEMI systems but quality improvement efforts have largely ignored STEMI occurring in patients hospitalized for a non-cardiac condition. Our recent single-center study showed inpatient STEMI to be associated with less use of revascularization and higher mortality rates than outpatient STEMI, but these findings have not been confirmed in multicenter cohorts.
Methods: STEMI admissions were identified from the 2011 California State Inpatient Database and classified as inpatient or outpatient based on diagnosis and present-on-admission codes. Patients who had non-STEMI, unstable angina or chest pain on admission were excluded from the analysis. Unadjusted comparisons were made using t- and chi-squared tests. Generalized linear models were used to evaluate associations between inpatient/outpatient status at onset of STEMI and outcomes, use of percutaneous coronary intervention (PCI), and resource utilization after adjustment for age, gender and comorbidities.
Results: Of 22369 STEMI-related admissions, 1729 occurred in hospitalized patients (7.8%; 5.4 per 10,000 admissions). Inpatient STEMI patients were older (72.7 ± 14.2 vs. 66.2 ± 14.4 years; p ≤ 0.001), more likely to be female (46.5 vs. 33.8%; p ≤ 0.001), and had more comorbidities, including history of heart failure (34.0 vs. 25.5%; p ≤ 0.001), peripheral vascular disease (16.0 vs. 9.5%; p ≤ 0.001) and chronic kidney disease (33.9 vs. 15.7%; p ≤ 0.001). After adjusting for age, gender, and comorbidities present on admission, inpatient STEMI patients were less likely to receive PCI (25.1 vs. 56.4%; p ≤ 0.001), more likely to die (32.7 vs. 12.9%; p ≤ 0.001) and less likely to be discharged home (37.2 vs. 65.2%; p ≤ 0.001). Adjusted length of stay (10.4 vs 5.0 days; p ≤ 0.001) and inpatient charges ($240,380 vs $139,456; p ≤ 0.001) were both higher for inpatient STEMI.
Conclusions: Patients who develop STEMI while hospitalized for a non-cardiac condition have less aggressive care, greater resource utilization and markedly increased mortality compared to outpatient STEMI. These results suggest that inpatient STEMI is an important target for future quality control initiatives.
- © 2013 by American Heart Association, Inc.