Abstract 14597: Impact of In-Hospital Onset on Mortality in Patients With ST-elevation Myocardial Infarction -A Sub-Analysis of J-MINUET study
Introduction: Limited data exist regarding the association between in-hospital onset of ST-elevation acute myocardial infarction (STEMI) and outcomes.
Methods: The Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET) is a prospective and multicenter registry. We enrolled 2,168 consecutive STEMI patients hospitalized to within 48 hours from onset during July 2012 to March 2014. We evaluated the characteristics and outcomes for STEMI patients with in-hospital onset (IHO) in the PCI-capable institution.
Results: Of all patients, 65 (3.0%) had IHO, and 2,103 (97.0%) had out-of-hospital onset (OHO). Among OHO patients, 1,230 (56.7%) patients admitted via emergency medical services, 282 (13.0%) by walking and 591 (27.3%) transferred from other medical institution. IHO patients were older (71±13 vs. 68±13; p=0.030) and had less current smoker (23% vs. 37%; p=0.029), more chronic kidney disease (56% vs. 42%; p=0.028), more old myocardial infarction (23% vs. 8.9%; p<0.001), more previous revascularization (32% vs. 12%; p<0.001), more previous stroke (20% vs. 10%; p=0.028), and more Killip classification ≥2 (40% vs. 25%; p=0.013) than OHO patients. Onset-to-balloon time of IHO was shorter than of OHO (152±264 vs. 465±540; p<0.001). There was no difference in the primary PCI rate between two groups (95% vs. 93%; p=0.53). The rates of In-hospital mortality and cardiovascular mortality was significantly higher in IHO than OHO patients (23.1% vs. 6.8%; p<0.001, and 12.3% vs. 6.5%; p=0.028, respectively). In multivariable analysis, IHO was an independent predictor of in-hospital mortality. (Table)
Conclusions: Patients who develop STEMI while in-hospital represent a high-risk subset of patients even in the PCI-capable institutions.
Author Disclosures: M. Fujino: None. T. Noguchi: None. S. Yasuda: None. K. Nakao: None. Y. Ozaki: None. K. Kimura: None. J. Ako: None. S. Suwa: None. K. Fujimoto: None. Y. Nakama: None. T. Morita: None. W. Shimizu: None. Y. Saito: None. A. Hirohata: None. Y. Morita: None. T. Inoue: None. A. Okamura: None. M. Uematsu: None. K. Hirata: None. K. Tanabe: None. Y. Shibata: None. M. Owa: None. S. Hokimoto: None. H. Funayama: None. N. Kokubu: None. K. Kozuma: None. S. Uemura: None. T. Tetsuya: None. K. Saku: None. S. Oshima: None. K. Nishimura: None. Y. Miyamoto: None. M. Ishihara: None.
- © 2016 by American Heart Association, Inc.