Open AccessMortality differences among patients with i n‐hospital ST‐elevation myocardial infarction
Author(s) -
Shahandeh Negeen,
Dai Xuming,
Jaski Brian,
Dave Ravi,
Jacobs Alice,
Denktas Ali,
Levine Glenn,
Markovic Daniela,
Smith Sidney C.,
Press Marcella Calfon
Publication year - 2020
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.23480
Subject(s) - medicine , myocardial infarction , observational study , context (archaeology) , emergency medicine , retrospective cohort study , cardiology , heart failure , paleontology , biology
Background In‐hospital ST‐elevation myocardial infarction (STEMI) is associated with a higher mortality rate than out‐of‐hospital STEMI. Quality measures and universal protocols for treatment of in‐hospital STEMI do not exist, likely contributing to delays in recognition and treatment. Hypothesis To analyze differences in mortality among three subsets of patients who develop in‐hospital STEMI. Methods This was a multicenter, retrospective observational study of patients who developed in‐hospital STEMI at six United States medical centers between 2008 and 2017. Patients were stratified into three groups: (1) cardiac, (2) periprocedure, or (3) noncardiac/nonpostprocedure. Outcomes examined include time from electrocardiogram (ECG) acquisition to cardiac catheterization lab arrival (ECG‐to‐CCL) and survival to discharge. Results We identified 184 patients with in‐hospital STEMI (mean age 68.7 years, 58.7% male). Group 1 (cardiac) patients had a shorter average ECG‐to‐CCL time (69 minutes) than group 2 (periprocedure, 215 minutes) and group 3 (noncardiac/nonpostprocedure, 199 minutes). Compared to group 1, survival to discharge was lower for group 2 (OR 0.33, P = .102) and group 3 (OR 0.20, P = .016). After adjusting for prespecified covariates, the relationship between group and survival showed a similar trend but did not reach statistical significance. Conclusions Patients who develop in‐hospital STEMI in the context of a preceding procedure or noncardiac illness appear to have longer reperfusion times and higher in‐hospital mortality than patients admitted with cardiac diagnoses. Larger studies are warranted to further investigate these observations. Health systems should place an increased emphasis on developing quality metrics and implementing quality improvement initiatives to improve outcomes for in‐hospital STEMI.