Author + information
- Justin Tiulim,
- Kevin Mak,
- Leonardo Clavijo,
- Anilkumar Mehra,
- Ray Matthews and
- David Shavelle
Timely use of primary percutaneous coronary intervention (PCI) is the standard of care for patients with ST segment elevation myocardial infarction (STEMI). Most patients with STEMI present via emergency medical services (EMS) or self transport to the emergency department (ED) and relatively little is known about the minority of patients that develop STEMI while hospitalized for non-cardiac conditions. The objective of this study was to analyze treatment times and clinical outcome for in-hospital STEMI patients.
This was a retrospective study of patients treated at Keck Medical Center of USC and Los Angeles County +USC Medical Center from 2009 to 2013. During the study period, 228 patients presented to the ED via EMS or self-transport with STEMI (ED STEMI Group, n=228) and 27 patients developed in-hospital STEMI (In-hospital STEMI Group, n=27). Demographics, treatment times and clinical outcome were compared between the ED STEMI Group and the In-hospital STEMI Group.
Patients with In-hospital STEMI were older (61±11 vs. 59±12; p<0.05) and less likely to be male (66% vs. 76%; p <0.05) compared to ED STEMI patients. In-hospital STEMI patients were less likely to present with chest pain compared to ED STEMI patients, 5% vs. 79%, respectively, p<0.001. Angiographic findings for the In-hospital STEMI Group included: plaque rupture (n=20), Takutsubo cardiomyopathy (n=2), normal coronary arteries (n=3) and multivessel coronary artery disease (n=1). Time from first abnormal electrocardiogram to PCI was 195±202 mins for patients with In-hospital STEMI compared to door to balloon time of 62±39 mins for ED STEMI patients. The prevalence of cardiogenic shock was significantly higher in the In-hospital STEMI Group compared to the ED STEMI Group, 42% vs 4.4%, respectively, p<0.001. In-hospital mortality was significantly higher for the In-hospital STEMI Group compared to the ED STEMI Group, 37% vs. 7.1%, respectively, p<0.001.
In-hospital STEMI patients have significant treatment delays, a high prevalence of cardiogenic shock and worse clinical outcome compared to STEMI patients that present via the emergency department. Additional efforts are required to promptly identify in-hospital patients that develop STEMI.