title: Acute ST-elevation myocardial infarction in patients hospitalized for noncardiac conditions.
abstract: BACKGROUND
  Major advances have been made in the treatment of ST-elevation myocardial infarction (STEMI) in outpatients. In contrast, little is known about outcomes in STEMI that occur in patients hospitalized for a noncardiac condition.
  
  
  RESULTS
  This was a retrospective, single-center study of inpatient STEMIs from January 1, 2007, to July 31, 2011. Forty-eight cases were confirmed to be inpatient STEMIs of a total of 139 410 adult discharges. These patients were older and more often female and had higher rates of chronic kidney disease and prior cerebrovascular events compared with 227 patients with outpatient STEMIs treated during the same period. Onset of inpatient STEMI was heralded most frequently by a change in clinical status (60%) and less commonly by patient complaints (33%) or changes on telemetry. Coronary angiography and percutaneous coronary intervention were performed in 71% and 56% of patients, respectively. The median time to obtain ECG (41 [10, 600] versus 5 [2, 10] minutes; P<0.001), ECG to angiography time (91 [26, 209] versus 35 [25, 46] minutes; P<0.001) and ECG to first device activation (FDA) (129 [65, 25] versus 60 [47, 76] minutes; P<0.001) were longer for inpatient versus outpatient STEMI. Survival to discharge was lower for inpatient STEMI (60% versus 96%; P<0.001), and this difference persisted after adjusting for potential confounders.
  
  
  CONCLUSIONS
  Patients who develop a STEMI while hospitalized for a noncardiac condition are older and more often female, have more comorbidities, have longer ECG-to-FDA times, and are less likely to survive than patients with an outpatient STEMI.
authors.affiliation: Division of Cardiology, University of North Carolina, Chapel Hill, NC 27599-7075, USA.
authors.forename: Xuming
authors.initials: X
authors.lastname: Dai
authors.forename: Joseph
authors.initials: J
authors.lastname: Bumgarner
authors.forename: Andrew
authors.initials: A
authors.lastname: Spangler
authors.forename: Dane
authors.initials: D
authors.lastname: Meredith
authors.forename: Sidney C
authors.initials: SC
authors.lastname: Smith
authors.forename: George A
authors.initials: GA
authors.lastname: Stouffer
mesh_terms: D000046:Academic Medical Centers; D017677:Age Distribution; D000368:Aged; D015897:Comorbidity; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D062645:Percutaneous Coronary Intervention; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012189:Retrospective Studies; D017678:Sex Distribution; D020521:Stroke / Q000453:epidemiology*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
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