Inpatient versus outpatient onsets of acute myocardial infarction
Paul Erne1, Osmund Bertel2, Philip Urban3
1AMIS Plus, Hirschengraben 84, CH-8001 Zurich, Switzerland; Department of Cardiology, Cardiology Clinic, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland.
Insights
Patients experiencing acute myocardial infarction (AMI) while already hospitalized face higher mortality risks compared to those developing AMI outside the hospital. Early identification and management are crucial for this vulnerable inpatient population.
Area of Science:
- Cardiology
- Hospital Medicine
- Critical Care Medicine
Background:
- Acute myocardial infarction (AMI) occurring during hospitalization (inpatient-onset AMI) is understudied.
- Limited research exists comparing outcomes of inpatient-onset AMI versus outpatient-onset AMI.
Purpose of the Study:
- To compare characteristics and in-hospital mortality of patients with inpatient-onset AMI versus outpatient-onset AMI.
- To identify risk factors and management differences in these patient groups.
Main Methods:
- Analysis of 35,394 AMI patients from the AMIS Plus registry (2002-2014).
- Comparison of in-hospital mortality as the primary endpoint.
- Inclusion of patients admitted for medical or surgical reasons.
Main Results:
- Inpatient-onset AMI occurred in 1% of patients (n=356), who were older, more often female, and had higher comorbidity profiles (hypertension, diabetes, coronary artery disease).
- These patients received less frequent percutaneous coronary intervention and guideline-directed medical therapies (aspirin, P2Y12 inhibitors, statins).
- Crude in-hospital mortality was significantly higher (14.3% vs. 5.5%), with inpatient-onset AMI being an independent predictor of mortality (OR 2.35).
Conclusions:
- In-hospital-onset AMI is associated with a substantially increased risk of death.
- Improved identification of hospitalized patients at risk for AMI is necessary for timely and appropriate management.
Background:
There are few studies on patients suffering acute myocardial infarction (AMI) when already in hospital for other reasons; therefore, this study aimed to compare patients with in-hospital-onset AMI admitted for either medical or surgical reasons versus patients with outpatient-onset AMI.
Methods:
Patients enrolled in the AMIS Plus registry from 2002 to 2014 were analyzed. The main endpoint was in-hospital mortality.
Results:
Among 35,394 AMI patients, 356 (1%) had inpatient-onset AMI following hospital admission due to other pathologies (surgical 175, non-surgical 181). These patients were older (74 vs. 66 years; P<0.001), more often female (35% vs. 27%; P<0.001), had less frequently ST-elevation myocardial infarction (35.5% vs. 55.5%; P<0.001), but higher risk profiles: hypertension (83% vs. 62%; P<0.001), diabetes (28% vs. 20%; P=0.001), known coronary artery disease (54% vs. 35%; P<0.001), and more comorbidities (Charlson Comorbidity Index above 1 in 51% vs. 22%; P<0.001) than those with outpatient-onset AMI. Percutaneous coronary intervention was less frequently applied (OR 0.45; 95% CI 0.36-0.57), and they were less likely to be treated with aspirin (OR 0.43; 95% CI 0.37-0.59), P2Y12 blockers (OR 0.42; 0.34-0.52) or statins (OR 0.51; 95% CI 0.41-0.63). Crude mortality was higher (14.3% vs. 5.5%; P<0.001) and inpatient-onset AMI was an independent predictor of in-hospital mortality (OR 2.35; 95% CI 1.63-3.39; P<0.001).
Conclusions:
Patients with in-hospital-onset AMI were at greater risk of death than those with outpatient-onset AMI. More work is needed to improve the identification of hospitalized patients at risk of AMI in order to provide the appropriate management.
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:26Acute Coronary Syndrome V: Nursing Management
01:27Myocarditis II: Clinical Features and Diagnostic Tests