Adverse outcomes in hospitalized patients who develop ST-elevation myocardial infarction
Tyler Richmond1, Noa Holoshitz, Anand Haryani
1From the *Central Baptist Heart and Vascular Institute, Lexington, KY; †Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL; and ‡Department of Emergency Medicine, Rush University Medical Center, Chicago, IL.
Insights
Patients hospitalized with ST-elevation myocardial infarction (STEMI) face worse outcomes, including delayed treatment and higher mortality, compared to those presenting to the emergency department (ED). Optimized care pathways for inpatients are crucial.
Area of Science:
- Cardiology
- Emergency Medicine
- Hospital Medicine
Background:
- Protocols for ST-elevation myocardial infarction (STEMI) focus on emergency department (ED) identification and treatment.
- A subset of STEMI cases occurs in hospitalized patients for other conditions.
Purpose of the Study:
- To compare outcomes of STEMI patients who presented to the ED versus those who developed STEMI while hospitalized.
Main Methods:
- Retrospective chart review of 172 consecutive STEMI patients undergoing percutaneous coronary intervention.
- Comparison between 137 ED STEMI patients and 35 hospitalized STEMI patients.
Main Results:
- Hospitalized STEMI patients experienced delayed reperfusion.
- In-hospital STEMI was associated with longer hospital stays, increased stent thrombosis, and higher 30-day and 1-year mortality.
- ED STEMI patients had better outcomes.
Conclusions:
- Urgent need for improved clinical pathways for prevention, diagnosis, and treatment of STEMI in hospitalized patients.
- Current care gaps for inpatient STEMI require addressing.
Background:
There has been considerable emphasis on the care of patients with ST-elevation myocardial infarction (STEMI) with the wide implementation of protocols to quickly identify and triage them from the emergency department (ED) to a cardiac catheterization laboratory for percutaneous coronary intervention. However, a small but important number of patients with STEMI develop ST-elevation while hospitalized for another medical problem.
Methods:
A single-center, retrospective chart review was performed on 172 consecutive patients with STEMI who underwent emergency percutaneous coronary intervention. One hundred thirty-seven patients presenting to the ED with STEMI and 35 patients who developed STEMI while hospitalized were compared.
Results:
Hospitalized patients with STEMI had delayed reperfusion, longer hospitalization, greater rates of stent thrombosis, and greater 30-day and 1-year mortality compared with these in patients presenting with STEMI to the ED.
Conclusions:
Optimized clinical pathways for prevention, early diagnosis, and expedited reperfusion of inpatients with STEMI are urgently needed.
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