Reassess Hospital Costs and Mortality Between Myocardial Infarction With and Without ST-Segment Elevation in a Modern
Honglan Ma1, Sen Wu1, Jinlong Cao1
1Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China.
Insights
ST-segment elevation myocardial infarction (STEMI) patients incur higher hospitalization costs and longer stays than non-ST-segment elevation myocardial infarction (NSTEMI) patients. Despite higher mortality risk, in-hospital deaths were not statistically significant between groups.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- ST-segment elevation myocardial infarction (STEMI) is associated with increased hospitalization costs and poorer prognosis compared to non-ST-segment elevation myocardial infarction (NSTEMI).
- Understanding these differences is crucial for resource allocation and patient management.
Purpose of the Study:
- To investigate and compare the clinical characteristics, hospitalization costs, and mortality rates between STEMI and NSTEMI patients.
- To identify risk factors associated with mortality in myocardial infarction patients.
Main Methods:
- A retrospective study analyzed 758 STEMI and 386 NSTEMI patients from January 2020 to May 2023.
- Data collected included clinical symptoms, laboratory markers (troponin I, NT-proBNP), left ventricular ejection fraction (LVEF), hypotension, use of intra-aortic balloon pump (IABP), hospitalization costs, length of stay, and in-hospital mortality.
- Multivariable logistic regression was employed to identify mortality risk factors.
Main Results:
- STEMI patients exhibited higher maximal troponin I levels and lower LVEF compared to NSTEMI patients.
- STEMI patients had a significantly higher incidence of hypotension and greater utilization of IABP.
- Hospitalization costs and length of stay were significantly higher for STEMI patients, though in-hospital mortality did not differ significantly.
- Systolic blood pressure and NT-proBNP were identified as risk factors for patient death.
Conclusions:
- STEMI patients present with more severe cardiac dysfunction, leading to higher hospitalization costs and longer hospital stays.
- Complications such as cardiogenic shock and heart failure are more prevalent in STEMI cases, necessitating advanced interventions like IABP.
- While STEMI patients face greater risks, timely and appropriate management can mitigate mortality differences.
Background:
Patients with ST-segment elevation myocardial infarction (STEMI) may have higher hospitalization costs and poorer prognosis than non-ST-segment elevation myocardial infarction (NSTEMI).
Methods:
A single-center retrospective study was conducted on 758 STEMI patients and 386 NSTEMI patients from January 1, 2020 to May 30, 2023 aimed to investigate the differences in cost and mortality.
Results:
STEMI patients had higher maximal troponin I (15,222.5 (27.18, 40,000.00) vs. 2731.5 (10.73, 27,857.25), p < 0.001) and lower left ventricular ejection fraction (LVEF) (56% (53%, 59%) vs. 57% (55%, 59%), p < 0.001) compared to NSTEMI patients. The clinical symptoms were mainly persistent or interrupted chest pain/distress in either STEMI or NSTEMI patients. STEMI patients had a significantly higher risk of combined hypotension than NSTEMI patients (8.97% vs. 3.89%, p = 0.002), and IABP was much more frequently used in the STEMI group with a statistical difference (2.90% vs. 0.52%, p = 0.015). STEMI patients have statistically higher hospitalization costs (RMB, ¥) (31,667 (25,337.79, 39,790) vs. 30,506.91 (21,405.96, 40,233.75), p = 0.006) and longer hospitalization days (10 (8, 11) vs. 9 (8, 11), p = 0.001) compared to NSTEMI patients. Although in-hospital mortality was higher in STEMI patients, the difference was not statistically significant (3.56% vs. 2.07%, p = 0.167). Multivariable logistic regression was performed and found that systolic blood pressure and NT-proBNP were risk factors for patient death (OR ≥ 1).
Conclusion:
STEMI patients are more likely comorbid cardiogenic shock, heart failure complications with higher hospitalization costs and longer hospitalization days. And relatively more use of acute mechanical circulatory support devices such as IABP.
Trial Registration:
ChiCTR2300077885.
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