Adverse outcomes in hospitalized patients who develop ST-elevation myocardial infarction.
BACKGROUND
There has been considerable emphasis on the care of patients with ST-elevation myocardial infarction (STEMI) with the wide implementation of protocols to quickly identify and triage them from the emergency department (ED) to a cardiac catheterization laboratory for percutaneous coronary intervention. However, a small but important number of patients with STEMI develop ST-elevation while hospitalized for another medical problem.


METHODS
A single-center, retrospective chart review was performed on 172 consecutive patients with STEMI who underwent emergency percutaneous coronary intervention. One hundred thirty-seven patients presenting to the ED with STEMI and 35 patients who developed STEMI while hospitalized were compared.


RESULTS
Hospitalized patients with STEMI had delayed reperfusion, longer hospitalization, greater rates of stent thrombosis, and greater 30-day and 1-year mortality compared with these in patients presenting with STEMI to the ED.


CONCLUSIONS
Optimized clinical pathways for prevention, early diagnosis, and expedited reperfusion of inpatients with STEMI are urgently needed.
From the *Central Baptist Heart and Vascular Institute, Lexington, KY; †Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL; and ‡Department of Emergency Medicine, Rush University Medical Center, Chicago, IL.
Tyler
T
Richmond
Noa
N
Holoshitz
Anand
A
Haryani
Yanina
Y
Purim-Shem-Tov
Gaurav
G
Sharma
Gary L
GL
Schaer
D000368:Aged; D042241:Early Diagnosis; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies; D013997:Time Factors; D014218:Triage / Q000379:methods*