Mortality differences among patients with in-hospital ST-elevation myocardial infarction.
Aged
Coronary Angiography
Electrocardiography
Emergency Medical Services
/ statistics & numerical data
Female
Follow-Up Studies
Hospital Mortality
/ trends
Humans
Inpatients
Male
Quality Improvement
Retrospective Studies
Risk Factors
ST Elevation Myocardial Infarction
/ diagnosis
Survival Rate
/ trends
Time-to-Treatment
United States
/ epidemiology
acute coronary syndrome
ischemic heart disease
myocardial infarction
percutaneous coronary intervention
Journal
Clinical cardiology
ISSN: 1932-8737
Titre abrégé: Clin Cardiol
Pays: United States
ID NLM: 7903272
Informations de publication
Date de publication:
Dec 2020
Dec 2020
Historique:
received:
20
07
2020
revised:
30
09
2020
accepted:
04
10
2020
pubmed:
8
11
2020
medline:
10
8
2021
entrez:
7
11
2020
Statut:
ppublish
Résumé
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. To analyze differences in mortality among three subsets of patients who develop in-hospital STEMI. 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. 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. 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.
Sections du résumé
BACKGROUND
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
OBJECTIVE
To analyze differences in mortality among three subsets of patients who develop in-hospital STEMI.
METHODS
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
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
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.
Identifiants
pubmed: 33159461
doi: 10.1002/clc.23480
pmc: PMC7724232
doi:
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1555-1561Informations de copyright
© 2020 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.
Références
J Am Coll Cardiol. 2006 Jun 6;47(11):2180-6
pubmed: 16750682
J Am Heart Assoc. 2013 Apr 04;2(2):e000004
pubmed: 23557748
Circulation. 2006 May 2;113(17):2152-63
pubmed: 16569790
JAMA. 2012 Feb 22;307(8):813-22
pubmed: 22357832
Circulation. 2014 Mar 18;129(11):1225-32
pubmed: 24389237
J Am Coll Cardiol. 2009 Dec 15;54(25):2423-9
pubmed: 20082933
JAMA. 2014 Nov 19;312(19):1999-2007
pubmed: 25399275
JACC Cardiovasc Interv. 2008 Feb;1(1):97-104
pubmed: 19393152
Nat Rev Cardiol. 2016 Mar;13(3):148-54
pubmed: 26525542
Clin Cardiol. 2020 Dec;43(12):1555-1561
pubmed: 33159461
JAMA Cardiol. 2018 Jun 1;3(6):527-531
pubmed: 29466558