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Predictors, treatment, and outcomes of STEMI occurring in hospitalized patients
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Predictors, treatment, and outcomes of STEMI occurring in hospitalized patients
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Journal Article
Predictors, treatment, and outcomes of STEMI occurring in hospitalized patients
2016
Overview
Key Points
ST-segment elevation myocardial infarction (STEMI) can occur outside of hospital (outpatient STEMI) or in hospitalized patients (inpatient STEMI)
Inpatient STEMI is associated with older age, a higher female:male ratio, and more comorbidities than outpatient STEMI
Inpatient STEMI is often associated with clinical presentations that are atypical compared with those of outpatient STEMI
Inpatient STEMI is associated with an in-hospital mortality 3–10-fold greater than that of outpatient STEMI
Primary percutaneous coronary intervention is used much less commonly and times-to-reperfusion are longer for inpatient STEMI than for outpatient STEMI
In addition to high-risk clinical profiles, in-hospital system delays in electrocardiogram acquisition, interpretation, and STEMI diagnosis can also contribute to unfavourable outcomes of inpatient STEMI
Systems of care have been established to optimize treatment of ST-segment elevation myocardial infarction (STEMI) occurring out of hospital, but not for patients in hospital. Unfavourable clinical characteristics of patients, combined with suboptimal strategies for diagnosis and treatment, mean that inpatient STEMI is associated with high mortality. Eliminating system delays and increasing use of reperfusion therapy could improve outcomes for inpatient STEMI.
ST-segment elevation myocardial infarction (STEMI) is most commonly caused by an acute thrombotic occlusion of a coronary artery. For patients in whom the onset of STEMI occurs outside of hospital (outpatient STEMI), early reperfusion therapy with either fibrinolysis or primary percutaneous coronary intervention reduces complications and improves survival, compared with delayed reperfusion. STEMI systems of care are defined as integrated groups of separate entities focused on reperfusion therapy for STEMI, generally including emergency medical services, emergency medicine, cardiology, nursing, and hospital administration. These systems of care have been successful at reducing total ischaemia time and outpatient STEMI mortality. By contrast, much less is known about STEMI that occurs in hospitalized patients (inpatient STEMI), which has unique clinical features and much worse outcomes than outpatient STEMI. Inpatient STEMI is associated with older age, a higher female:male ratio, and more comorbidities than outpatient STEMI. Delays in diagnosis and infrequent use of reperfusion therapy probably also contribute to unfavourable outcomes for inpatient STEMI.
Publisher
Nature Publishing Group UK,Nature Publishing Group
