title: High mortality with ST elevation myocardial infarction in a nontrial setting.
abstract: BACKGROUND
  Early mortality following ST elevation myocardial infarction (MI) is declining in trial and nontrial settings. Absolute rates in nontrial settings remain significantly higher than those seen in randomized controlled trials. It is unclear if this mortality difference is due to different patient characteristics or to less frequent use of reperfusion strategies.
  
  
  OBJECTIVE
  To provide a descriptive analysis of contemporary management and outcome of ST elevation MI in a nontrial setting at a tertiary care hospital, and to compare the clinical characteristics and in-hospital mortality of patients with ST elevation MI who were or were not treated with reperfusion therapy.
  
  
  METHODS
  A retrospective chart review of 115 patients with ST elevation MI from July 1999 to June 2000 was performed.
  
  
  RESULTS
  Eighty-five of 109 (78%) eligible patients received reperfusion therapy--44% fibrinolysis, 27% primary percutaneous coronary intervention (PCI) and 7% rescue PCI. Twenty-two per cent of eligible patients received no form of reperfusion therapy. In-hospital mortality was higher among patients who received no reperfusion therapy than among those who had (50% versus 11%, respectively, P<0.001). Patients who did not receive reperfusion therapy were older, presented with a longer median duration of chest pain, had a higher incidence of Killip class III or IV, and had a higher mean Thrombolysis in Myocardial Infarction (TIMI) risk score; many had absolute or relative contraindications to fibrinolytic therapy, and a significant proportion presented with a duration of chest pain of 12 h to 24 h.
  
  
  CONCLUSIONS
  Mortality in ST elevation MI is disproportionately higher among patients who receive no reperfusion therapy. Many of these patients have clinical characteristics that may affect the physician's decision to provide reperfusion therapy. Improving overall survival among patients with ST elevation MI will be contingent on optimizing the number of patients receiving reperfusion therapy.
authors.affiliation: University of Toronto, Toronto, Ontario, Canada.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Shufelt
authors.forename: Fran L
authors.initials: FL
authors.lastname: Paradiso-Hardy
authors.forename: John
authors.initials: J
authors.lastname: Papastergiou
authors.forename: Eric A
authors.initials: EA
authors.lastname: Cohen
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002423:Cause of Death; D017023:Coronary Angiography; D003325:Coronary Care Units; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D015425:Myocardial Reperfusion / Q000379:methods; D009864:Ontario / Q000453:epidemiology; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis; D015912:Thrombolytic Therapy / Q000379:methods