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Original Article

ST Elevation Myocardial Infarction Diagnosed after Hospital Admission

Ross F. Garberich, Jay H. Traverse, Michael T. Claussen, Gabriel Rodriguez, Anil K. Poulose, Ivan J. Chavez, Stephanie Rutten-Ramos, David A. Hildebrandt, Timothy D. Henry
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https://doi.org/10.1161/CIRCULATIONAHA.113.005568
Circulation. 2014;CIRCULATIONAHA.113.005568
Originally published January 3, 2014
Ross F. Garberich
Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN
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Jay H. Traverse
Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN
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Michael T. Claussen
Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN
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Gabriel Rodriguez
Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN
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Anil K. Poulose
Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN
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Ivan J. Chavez
Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN
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Stephanie Rutten-Ramos
Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN
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David A. Hildebrandt
Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN
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Timothy D. Henry
Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN
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  • For correspondence: henry003@tc.umn.edu
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Abstract

Background—Treatment times for ST-elevation myocardial infarction (STEMI) patients presenting to percutaneous coronary intervention (PCI) hospitals have improved dramatically over the last 10 years, particularly for patients using emergency medical services (EMS). Limited data exist regarding treatment times and outcomes for patients who develop STEMI after hospital admission.

Methods and Results—Using a comprehensive prospective regional STEMI program database, we evaluated characteristics and outcomes for patients who develop STEMI after hospital admission. Of the 3,795 consecutive STEMI patients treated using the Minneapolis Heart Institute regional STEMI program from March 2003 to January 2013, 990 (26.1%) presented initially to the PCI facility, including 640 arriving via EMS, 267 self/family driven, and 83 already admitted to the hospital. Patients with in-hospital presentation were older with higher BMIs, were more likely to have hypertension and present with pre-PCI cardiac arrest and cardiogenic shock. Door-to-balloon times (diagnostic EKG-to-balloon for in-hospital patients) were longer than EMS patients (76 vs. 51 minutes; p<0.001), but similar to self/family driven patients (76 vs. 66 minutes; p=0.13). In-hospital patients had longer lengths-of-stay (LOS) (5 vs. 3 vs. 3 days; p<0.001) and higher 1-year mortality (16.9% vs. 10.3% vs. 7.1%; p=0.032). These patients frequently had high-risk and complex reasons for admission including 30.1% with acute coronary syndrome, 24.1% post-surgery, 12.1% respiratory failure and 8.4% ventricular fibrillation.

Conclusions—Patients who develop STEMI while in-hospital represent a unique, high-risk subset of patients. They have increased treatment time and LOS and higher mortality than those presenting via EMS or who are self/family driven.

  • in-hospital STEMI
  • delivery of health care
  • standardized protocol
  • myocardial infarction
  • reperfusion
  • Received August 8, 2013.
  • Revision received November 13, 2013.
  • Accepted November 20, 2013.
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    ST Elevation Myocardial Infarction Diagnosed after Hospital Admission
    Ross F. Garberich, Jay H. Traverse, Michael T. Claussen, Gabriel Rodriguez, Anil K. Poulose, Ivan J. Chavez, Stephanie Rutten-Ramos, David A. Hildebrandt and Timothy D. Henry
    Circulation. 2014;CIRCULATIONAHA.113.005568, originally published January 3, 2014
    https://doi.org/10.1161/CIRCULATIONAHA.113.005568

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    ST Elevation Myocardial Infarction Diagnosed after Hospital Admission
    Ross F. Garberich, Jay H. Traverse, Michael T. Claussen, Gabriel Rodriguez, Anil K. Poulose, Ivan J. Chavez, Stephanie Rutten-Ramos, David A. Hildebrandt and Timothy D. Henry
    Circulation. 2014;CIRCULATIONAHA.113.005568, originally published January 3, 2014
    https://doi.org/10.1161/CIRCULATIONAHA.113.005568
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