title: Inpatient versus outpatient onsets of acute myocardial infarction.
abstract: BACKGROUND
  There are few studies on patients suffering acute myocardial infarction (AMI) when already in hospital for other reasons; therefore, this study aimed to compare patients with in-hospital-onset AMI admitted for either medical or surgical reasons versus patients with outpatient-onset AMI.
  
  
  METHODS
  Patients enrolled in the AMIS Plus registry from 2002 to 2014 were analyzed. The main endpoint was in-hospital mortality.
  
  
  RESULTS
  Among 35,394 AMI patients, 356 (1%) had inpatient-onset AMI following hospital admission due to other pathologies (surgical 175, non-surgical 181). These patients were older (74 vs. 66 years; P<0.001), more often female (35% vs. 27%; P<0.001), had less frequently ST-elevation myocardial infarction (35.5% vs. 55.5%; P<0.001), but higher risk profiles: hypertension (83% vs. 62%; P<0.001), diabetes (28% vs. 20%; P=0.001), known coronary artery disease (54% vs. 35%; P<0.001), and more comorbidities (Charlson Comorbidity Index above 1 in 51% vs. 22%; P<0.001) than those with outpatient-onset AMI. Percutaneous coronary intervention was less frequently applied (OR 0.45; 95% CI 0.36-0.57), and they were less likely to be treated with aspirin (OR 0.43; 95% CI 0.37-0.59), P2Y12 blockers (OR 0.42; 0.34-0.52) or statins (OR 0.51; 95% CI 0.41-0.63). Crude mortality was higher (14.3% vs. 5.5%; P<0.001) and inpatient-onset AMI was an independent predictor of in-hospital mortality (OR 2.35; 95% CI 1.63-3.39; P<0.001).
  
  
  CONCLUSIONS
  Patients with in-hospital-onset AMI were at greater risk of death than those with outpatient-onset AMI. More work is needed to improve the identification of hospitalized patients at risk of AMI in order to provide the appropriate management.
authors.affiliation: AMIS Plus, Hirschengraben 84, CH-8001 Zurich, Switzerland; Department of Cardiology, Cardiology Clinic, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland.
authors.forename: Paul
authors.initials: P
authors.lastname: Erne
authors.affiliation: Cardiology Center, Klinik im Park, Seestrasse 220, CH-8027 Zurich, Switzerland.
authors.forename: Osmund
authors.initials: O
authors.lastname: Bertel
authors.affiliation: Cardiovascular Department, La Tour Hospital, 3, avenue J.-D. Maillard, CH-1217 Geneva, Switzerland.
authors.forename: Philip
authors.initials: P
authors.lastname: Urban
authors.affiliation: Division of Cardiology, Cardiocentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pedrazzini
authors.affiliation: University Heart Center, Department of Cardiology, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lüscher
authors.affiliation: AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001 Zurich, Switzerland. Electronic address: dragana.radovanovic@uzh.ch.
authors.forename: Dragana
authors.initials: D
authors.lastname: Radovanovic
mesh_terms: D000368:Aged; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D010045:Outpatients / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors
keywords: Acute myocardial infarction; Outcome; Symptom in hospital