Comparison between Invasive Intervention and Conservative Treatment in Patients with In-Hospital Myocardial
Mohamad Assaf1, Daniela Costa1, Ljupcho Efremov2
1Institute for Medical Epidemiology, Biometrics and Informatics, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
Insights
In-hospital heart attacks are less likely to receive invasive treatment. Invasive intervention for in-hospital myocardial infarctions (AMIs) was linked to lower 30-day mortality compared to conservative care.
Area of Science:
- Cardiology
- Clinical Medicine
- Public Health
Background:
- In-hospital myocardial infarctions (AMIs) are often managed conservatively compared to out-of-hospital AMIs.
- Understanding treatment disparities and outcomes is crucial for improving patient care.
Purpose of the Study:
- To identify factors influencing invasive intervention in patients with in-hospital AMIs.
- To assess the association between invasive intervention and 30-day mortality versus conservative treatment.
Main Methods:
- Cross-sectional study utilizing data from The Regional Myocardial Infarction Registry of Saxony-Anhalt.
- Logistic regression analysis to determine predictors of invasive intervention and its impact on mortality.
- Comparison of patient characteristics and outcomes between invasive and conservative treatment groups.
Main Results:
- Nearly 67% of patients with in-hospital AMIs received invasive intervention.
- Younger age, absence of heart failure, and lower heart rate were associated with lower odds of receiving invasive intervention.
- Hypertension and STEMI (ST-elevation myocardial infarction) were associated with higher odds of invasive intervention. Invasive intervention was linked to significantly lower 30-day mortality (OR = 0.25).
Conclusions:
- A significant proportion of in-hospital AMIs are treated conservatively.
- Key determinants for invasive intervention include younger age, absence of heart failure, lower heart rate, hypertension, and STEMI.
- Invasive intervention demonstrates a potential survival benefit in the short term for in-hospital AMIs, warranting further investigation.
Abstract:
Background/Objectives: In-hospital myocardial infarctions (AMIs) are less often treated with invasive intervention, compared to out-of-hospital AMIs. We aimed to identify the determinants of invasive intervention in patients with in-hospital AMIs and assess its association with mortality, compared to conservative treatment. Methods: This was a cross-sectional study of in-hospital AMIs in The Regional Myocardial Infarction Registry of Saxony-Anhalt. Patients' characteristics and outcomes were compared based on the treatment strategy (invasive intervention vs. conservative treatment). Logistic regression was performed to assess the determinants of invasive intervention (vs. conservative treatment) and its association with 30-day mortality. Results: Nearly 67% of the patients (259/386) received invasive intervention, and the rest were treated conservatively. Those who were treated with an invasive intervention were younger and had a lower proportion of chronic heart failure than those treated conservatively. Age > 75 years compared to younger patients, pre-existing heart failure, and higher heart rate upon presentation were associated with lower odds of receiving invasive intervention. Hypertension (OR = 2.86, 95% CI [1.45-5.62]) and STEMI vs. NSTEMI (1.96, [1.10-3.68]) were associated with higher odds of invasive intervention. The adjusted odds of 30-day mortality were lower with invasive intervention compared to conservative treatment (0.25, [0.10-0.67]). Conclusions: One-third of the patients with in-hospital AMIs received conservative treatment. Younger age, absence of heart failure, lower heart rate, hypertension, and STEMI were determinants of invasive intervention usage. Invasive intervention had lower odds of 30-day mortality, but longitudinal studies are still needed to assess the efficacy of conservative vs. invasive strategies in in-hospital AMIs.
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