Impact of In-Hospital STEMI on Reperfusion Times and Clinical Outcomes.

BACKGROUND: ST-segment-elevation myocardial infarction (STEMI) is uncommon among inpatients already admitted to the hospital for other indications. Prior studies reported significant differences in clinical characteristics and outcomes of patients who develop STEMI while hospitalized versus those who present with out-of-hospital STEMI. However, prior studies were small or not contemporary. METHODS: We compared the characteristics and outcomes of patients presenting with STEMI at the time of hospital admission (preadmission STEMI) versus in-hospital STEMI (occurring during the hospitalization) using data from the National Cardiovascular Data Registry Chest Pain-MI Registry from 2019 to 2022. RESULTS: A total of 112 590 patients (3.8% in-hospital STEMI, 96.2% preadmission STEMI) from 670 hospitals were included. Patients with in-hospital STEMI were significantly older (median age, 67 versus 63 years), more likely to be diabetic (37.6% versus 29.6%) and have congestive heart failure (13.7% versus 6.0%) compared with patients with preadmission STEMI (all P<0.001). The median (interquartile range) time from ECG to first device activation (81 minutes [61-110] versus 69 [55-84]; P<0.0001) and time from cath laboratory arrival to first device time (28 minutes [21-39] versus 23 [18-30]; P<0.001) were significantly longer for patients with in-hospital compared with preadmission STEMI. The incidence of major bleeding (25.5% versus 7.1%), cardiogenic shock (19.7% versus 7.0%), and cardiac arrest (22.3% versus 7.3%) were all significantly higher in the in-hospital STEMI cohort (all P<0.001), as was mortality (25.9% versus 5.6%; adjusted odds ratio, 5.7 [95% CI, 5.0-6.4]; P<0.001). CONCLUSIONS: Patients who experience in-hospital STEMI represent a high-risk group, with significantly longer times from the diagnostic ECG to primary percutaneous coronary intervention, more complications, and higher mortality.

Duke Scholars

Author Shuang Li  

Author Jennifer Anne Rymer Medicine, Cardiology

Author Karen Chiswell