Mortality differences among patients with in-hospital ST-elevation myocardial infarction.
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.
['Shahandeh|Negeen|N|https://orcid.org/0000-0002-7811-8063', 'Dai|Xuming|X|', 'Jaski|Brian|B|', 'Dave|Ravi|R|', 'Jacobs|Alice|A|', 'Denktas|Ali|A|', 'Levine|Glenn|G|', 'Markovic|Daniela|D|', 'Smith|Sidney C|SC|', 'Press|Marcella Calfon|MC|']
D000368:Aged D017023:Coronary Angiography D004562:Electrocardiography D004632:Emergency Medical Services D005260:Female D005500:Follow-Up Studies D017052:Hospital Mortality D006801:Humans D007297:Inpatients D008297:Male D058996:Quality Improvement D012189:Retrospective Studies D012307:Risk Factors D000072657:ST Elevation Myocardial Infarction D015996:Survival Rate D061665:Time-to-Treatment D014481:United States
myocardial infarction acute coronary syndrome ischemic heart disease percutaneous coronary intervention