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Published on: May 28, 2019
Mechanisms of ST Elevation Myocardial Infarction in Patients Hospitalized for Noncardiac Conditions
Khola Tahir1, Eric Pauley1, Xuming Dai2
1Division of Cardiology University of North Carolina, Chapel Hill, North Carolina.
Insights
ST elevation myocardial infarction (STEMI) in hospitalized patients has high mortality. This study found both thrombotic and non-thrombotic causes for in-hospital STEMI, highlighting the need for understanding these mechanisms to improve patient outcomes.
Area of Science:
- Cardiology
- Internal Medicine
- Critical Care Medicine
Background:
- ST elevation myocardial infarction (STEMI) in patients hospitalized for noncardiac conditions presents a significant mortality risk.
- Understanding the underlying mechanisms of in-hospital STEMI is crucial for improving patient care and outcomes.
Purpose of the Study:
- To investigate the mechanisms contributing to ST elevation myocardial infarction (STEMI) in patients hospitalized for noncardiac conditions.
- To compare the characteristics and outcomes of patients with thrombotic versus non-thrombotic in-hospital STEMI.
Main Methods:
- A single-center retrospective study involving 70 patients who experienced STEMI during hospitalization for a noncardiac condition and underwent coronary angiography.
- In-hospital STEMI was categorized as thrombotic if angiographic or intravascular imaging showed intracoronary thrombus, plaque rupture, or stent thrombosis.
- Etiologies were classified as thrombotic or non-thrombotic (e.g., vasospasm, supply-demand mismatch, takotsubo cardiomyopathy).
Main Results:
- Thrombotic etiologies accounted for 56% of in-hospital STEMI cases.
- Patients with thrombotic STEMI were more likely to have antiplatelet medications discontinued, higher peak troponin levels, and underwent percutaneous coronary intervention more often.
- Despite similar percutaneous coronary intervention use, thrombotic inpatient STEMI showed longer ECG to angiography times and a fivefold higher in-hospital mortality compared to out-of-hospital STEMI.
Conclusions:
- Both thrombotic and non-thrombotic mechanisms contribute to STEMI in hospitalized patients.
- In-hospital STEMI, particularly with thrombotic causes, is associated with a high mortality rate.
- Further research into the specific mechanisms and management strategies for in-hospital STEMI is warranted.
Abstract:
ST elevation myocardial infarction (STEMI) occurring in patients hospitalized for a noncardiac condition is associated with a high mortality rate and thus we sought to determine the mechanisms underlying STEMI in this patient population. This is a single center retrospective study of 70 patients who had STEMI while hospitalized on a noncardiac service and underwent coronary angiography. Thrombotic in-hospital STEMI was defined by angiographic or intravascular imaging evidence of intracoronary thrombus, plaque rupture, or stent thrombosis. Thirty-six (51%) inpatient STEMIs developed in the operating room or various postoperative stages and 6 (9%) after endoscopy or a percutaneous procedure. Thrombotic etiologies were found in 39 (56%) patients. Nonthrombotic etiologies included vasospasm, supply-demand mismatch, and takotsubo cardiomyopathy. Patients in the thrombotic group were more likely to have antiplatelet medications discontinued on admission, had higher peak troponin levels and were more likely to undergo percutaneous coronary intervention than patients in the nonthrombotic group. Exposure to vasopressors, time from ECG to angiography, post-STEMI ejection fraction, length of stay, and in-hospital mortality were similar in both groups. There was no difference in the use of percutaneous coronary intervention in patients but longer ECG to coronary angiography times and fivefold higher in-hospital mortality in thrombotic inpatient STEMI compared with 643 patients who presented with an out-of-hospital STEMI during the same time period. In conclusion, thrombotic and nonthrombotic mechanisms cause STEMI in hospitalized patients and are associated with a high mortality.
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