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Impact of In-Hospital STEMI on Reperfusion Times and Clinical Outcomes
Jennifer A Rymer1,2, Shuang Li2, Karen Chiswell2
1Division of Cardiology, Duke University Hospital, Durham, NC (J.A.R.).
Circulation. Cardiovascular Interventions
|February 3, 2026
Summary
In-hospital ST-segment-elevation myocardial infarction (STEMI) patients are older, have more comorbidities, and face longer treatment delays. These patients experience significantly higher rates of complications and mortality compared to those admitted with STEMI.
Area of Science:
- Cardiology
- Hospital Medicine
- Public Health
Background:
- ST-segment-elevation myocardial infarction (STEMI) is an uncommon but serious condition in hospitalized patients.
- Previous research on in-hospital STEMI versus out-of-hospital STEMI has been limited by small sample sizes and outdated data.
- Understanding the differences in patient profiles and outcomes is crucial for improving care.
Purpose of the Study:
- To compare the clinical characteristics and outcomes of patients who develop STEMI during hospitalization (in-hospital STEMI) versus those admitted with STEMI (preadmission STEMI).
- To analyze data from a large, contemporary registry to provide insights into this understudied patient population.
Main Methods:
- Utilized data from the National Cardiovascular Data Registry Chest Pain-MI Registry (2019-2022).
- Included 112,590 patients, categorizing them into in-hospital STEMI (3.8%) and preadmission STEMI (96.2%).
- Compared demographic, clinical, and outcome data between the two groups.
Main Results:
- In-hospital STEMI patients were older, more likely to have diabetes and congestive heart failure (CHF).
- Longer times were observed from ECG to device activation and from cath lab arrival to device time for in-hospital STEMI.
- Higher incidences of major bleeding, cardiogenic shock, cardiac arrest, and mortality were found in the in-hospital STEMI group.
Conclusions:
- In-hospital STEMI patients represent a high-risk cohort with worse outcomes.
- Delayed treatment times and increased complications contribute to higher mortality in this group.
- Further research and targeted interventions are needed to improve outcomes for hospitalized patients experiencing STEMI.
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