ST-elevation myocardial infarction diagnosed after hospital admission
Ross F Garberich1, Jay H Traverse, Michael T Claussen
1Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN.
Circulation
|January 7, 2014
Summary
Patients experiencing ST-elevation myocardial infarction (STEMI) after hospital admission face longer treatment times and higher mortality. This high-risk group requires specific attention within STEMI protocols for improved outcomes.
Area of Science:
- Cardiology
- Emergency Medicine
- Healthcare Management
Background:
- ST-elevation myocardial infarction (STEMI) treatment times have improved, especially for emergency medical services (EMS) patients.
- Limited data exist on STEMI treatment times and outcomes for patients admitted to the hospital before symptom onset.
Purpose of the Study:
- To evaluate the characteristics and outcomes of patients who develop STEMI after hospital admission.
- To compare in-hospital STEMI patients with those presenting via EMS or self-transport.
Main Methods:
- Analysis of a prospective regional STEMI program database (March 2003-January 2013).
- Inclusion of 3795 consecutive STEMI patients, with a focus on 990 (26.1%) presenting initially to the PCI facility.
- Categorization into EMS, self/family-driven, and in-hospital presentation groups.
Main Results:
- In-hospital STEMI patients were older, had higher BMIs, and more comorbidities like hypertension.
- Door-to-balloon times were longer for in-hospital patients (76 min) compared to EMS (51 min).
- In-hospital patients experienced longer hospital stays (5 days vs. 3 days) and significantly higher 1-year mortality (16.9% vs. 7.1-10.3%).
Conclusions:
- In-hospital STEMI patients represent a distinct, high-risk population.
- These patients face delayed treatment and worse outcomes compared to other STEMI presentations.
- Further research and tailored strategies are needed for this vulnerable patient subset.
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