Initial complications and factors related to prehospital mortality in acute myocardial infarction with ST segment
Fernando Rosell-Ortiz1, Francisco J Mellado-Vergel2, Patricia Fernández-Valle1
1Empresa Pública de Emergencias Sanitarias de Andalucía. Andalusian Health Ministry, Andalucía, Spain.
Insights
Prehospital mortality in ST-elevation myocardial infarction (STEMI) is linked to female sex, atypical symptoms, hypotension, left bundle branch block, extensive infarction, and ventricular fibrillation. Early complications in STEMI patients occur frequently before hospital arrival.
Area of Science:
- Cardiology
- Emergency Medicine
- Public Health
Background:
- Hospital mortality for ST-elevation myocardial infarction (STEMI) has declined.
- Prehospital mortality for STEMI remains a concern.
- Understanding prehospital factors is crucial for improving STEMI outcomes.
Purpose of the Study:
- To identify initial complications in STEMI patients.
- To determine factors associated with prehospital mortality in STEMI patients.
- To inform prehospital care strategies for STEMI.
Main Methods:
- Observational study using a prospective continuous register.
- Included patients of any age attended by out-of-hospital emergency teams.
- Logistic regression analysis identified factors associated with prehospital mortality.
Main Results:
- 2528 STEMI patients were included; 2.1% died prehospital.
- Common complications included ventricular fibrillation (8.4%) and hypotension (13.5%).
- Prehospital mortality was associated with female sex, atypical presentation, hypotension, LBBB, extensive infarction, and VF.
Conclusions:
- STEMI patients experience significant early prehospital complications.
- Prehospital mortality is linked to specific patient demographics and clinical factors.
- Targeting these factors in prehospital care may reduce STEMI deaths.
Objective:
Hospital mortality in myocardial infarction ST-elevation myocardial infarction has decreased in recent years, in contrast to prehospital mortality. Our objective was to determine initial complications and factors related to prehospital mortality in patients with acute myocardial infarction with ST segment elevation (STEMI).
Methods:
Observational study based on a prospective continuous register of patients of any age attended by out-of-hospital emergency teams in Andalusia between January 2006 and June 2009. This includes patients with acute coronary syndrome-like symptoms whose initial ECG showed ST elevation or presumably new left bundle branch block (LBBB). Epidemiological, prehospital data and final diagnostic were recorded. The study included all patients with STEMI on the register, without age restrictions. Forward stepwise logistic regression analysis was performed to control for confounders.
Results:
A total of 2528 patients were included, 24% were women. Mean age 63.4±13.4 years; 16.7% presented atypical clinical symptoms. Initial complications: ventricular fibrillation (VF) 8.4%, severe bradycardia 5.8%, third-degree atrial-ventricular (AV) block 2.4% and hypotension 13.5%. Fifty-two (2.1%) patients died before reaching hospital. Factors associated with prehospital mortality were female sex (OR 2.36, CI 1.28 to 4.33), atypical clinical picture (OR 2.31, CI 1.21 to 4.41), hypotension (OR 4.95, CI 2.60 to 9.20), LBBB (OR 4.29, CI 1.71 to 10.74), extensive infarction (ST elevation in ≥5 leads) (OR 2.53, CI 1.28 to 5.01) and VF (OR 2.82, CI 1.38 to 5.78).
Conclusions:
A significant proportion of patients with STEMI present early complications in the prehospital setting, and some die before reaching hospital. Prehospital mortality was associated with female sex and atypical presentation, as pre-existing conditions, and hypotension, extensive infarction, LBBB and VF on emergency team attendance.
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