Likelihood and predictors of ST-elevation in patients hospitalized for myocardial infarction
Ville Kytö1, Jussi Sipilä1, Päivi Rautava1
1Heart Center, Division of Clinical Neurosciences, Neurology and Clinical Research Center, Turku University Hospital, Turku, Finland; PET Center, Medicine, Neurology and Public Health, University of Turku, Turku, Finland.
Insights
ST-elevation myocardial infarction (STEMI) is less common in older adults and women. Conditions like diabetes and renal insufficiency are linked to non-ST-elevation myocardial infarction (NSTEMI).
Area of Science:
- Cardiology and Cardiovascular Research
- Public Health and Epidemiology
- Medical Diagnostics
Background:
- Emergency treatment for myocardial infarction (MI) depends on ST-elevation presence.
- Understanding ST-elevation MI (STEMI) prevalence and associated factors is crucial but limited across diverse populations.
Purpose of the Study:
- To investigate the likelihood of ST-elevation in myocardial infarction (MI).
- To identify patient characteristics associated with ST-elevation in MI.
Main Methods:
- A nationwide registry study encompassing 68,162 patients aged 30+ with MI.
- Data collected from 22 Finnish hospitals with angiolaboratory services over eight years.
- Analysis focused on the likelihood and patient features associated with ST-elevation.
Main Results:
- ST-elevation MI (STEMI) occurred in 37.5% of patients; non-STEMI in 62.5%.
- STEMI prevalence decreased significantly with age, particularly in octogenarians (24.7%).
- Men showed a higher relative risk for STEMI (13%) compared to women, with differences diminishing in older age groups. Conditions like diabetes, atrial fibrillation, and renal insufficiency were linked to non-STEMI.
Conclusions:
- ST-elevation in MI is more common in men and decreases with advancing age.
- Specific comorbidities (diabetes, atrial fibrillation, renal insufficiency, etc.) are associated with the absence of ST-elevation.
- These findings can aid in predicting the likelihood of ST-elevation in MI patients, potentially guiding treatment decisions.
Importance:
Emergency treatment options in myocardial infarction are guided by presence or absence of ST-elevations in electrocardiography. Occurrence and factors associated with ST-presentation in different population groups are however inadequately known.
Objective:
To determine likelihood and patient features associated with ST-elevations in myocardial infarction.
Design:
Nationwide registry study including 22 hospitals with angiolaboratory during an eight year period in Finland.
Setting:
Hospitalized care.
Participants:
68,162 consecutive patients aged ≥ 30 with myocardial infarction.
Measures:
Likelihood and patient features associated with presence of ST-elevations.
Results:
Myocardial infarction presented with ST-elevation in 37.5% (CI 37.0-37.9%) and without in 62.5% (CI 61.9-63.1%) of patients, p<0.0001. Majority of patients aged 30-59 years with myocardial infarction had ST-elevation, but among octogenarians ST-elevations were present in only 24.7%. Presence of ST-elevations decreased with age by estimated 15.6% (CI 15.0-16.2%) per 10 year increase (p<0.0001). Men aged 40-79 years had significantly higher rate for ST-elevation myocardial infarction compared to women. Sex-based difference in presentation of myocardial infarction declined with increasing age. Overall, men had a 13% (CI 11-15%, p<0.0001) higher relative risk for ST-elevations compared to women when adjusted for age and co-morbidities. Diabetes, atrial fibrillation, peripheral or cerebral artery disease, chronic pulmonary disease, malignancy, and renal insufficiency were associated with absence of ST-elevations in myocardial infarction in multivariate analysis.
Conclusions And Relevance:
Myocardial infarction presents with ST-elevations more commonly in men. Presence of ST-elevations decreases with increasing age. Diabetes, atrial fibrillation, peripheral or cerebral artery disease, chronic pulmonary disease, malignancy, and renal insufficiency are associated with absence of ST-elevations in myocardial infarction. These findings may help to predict likelihood of ST-elevations in a patient with myocardial infarction.
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