title: Clinical Profiles Related to Timing of Death, Including In-Hospital Deaths Before Admission, in Patients With ST-Elevation Myocardial Infarction.
abstract: Patients with ST-elevation myocardial infarction (STEMI) who die in hospital before inpatient admission are generally not included in clinical studies and registries, and the clinical profiles of patients who die earlier versus later are not well defined. We aimed to characterize all patients with STEMI who arrived at emergency departments in the province of Quebec (Canada) based on inpatient admission status and when they died. All patients who presented with symptoms and core laboratory-confirmed STEMI or left bundle branch block during 6 months in 82 hospitals in Quebec were included. Death certificates were used to identify nonadmitted deaths. Of the 2017 patients with STEMI, 340 (16.9%) died within 1 year. Of the latter, 63 (18.5%) were nonadmitted deaths (group A), 179 (52.6%) were deaths after admission but within 30 days (group B), and 98 (28.8%) were deaths after 30 days to 1 year (group C). Group A was younger and most often hemodynamically unstable, followed for both features by B then C. Earliest presentation from symptom onset and most frequent ambulance use were found in group A, followed by B, then C. Presenting electrocardiogram (ECG) features were most severe in A, then B, then C (more arrhythmias, more anterior STEMI, more leads with ST elevation, and higher ST elevation). Patients who died earliest had the least frequency of previous myocardial infarction, coronary revascularization, vascular disease, and heart failure, and the least noncardiac co-morbidity. In conclusion, patients with STEMI dying in hospital before inpatient admission contributed substantially to overall STEMI mortality. Although dying patients who presented earlier had severer presenting clinical profiles, they were paradoxically younger and had less co-morbidity. Previous co-morbidities may favor adaptive protective mechanisms on initial presentation with STEMI.
authors.affiliation: Unité d'évaluation cardiovasculaire, Institut national d'excellence en santé et en services sociaux (INESSS), Montreal, Quebec, Canada; Département multidisciplinaire de cardiologie, Institut universitaire de cardiologie et de pneumologie de Québec, Quebec, Quebec, Canada. Electronic address: peter.bogaty@fmed.ulaval.ca.
authors.forename: Peter
authors.initials: P
authors.lastname: Bogaty
authors.affiliation: Département de médecine, Montreal Heart Institute, Montreal, Quebec, Canada.
authors.forename: Philippe L
authors.initials: PL
authors.lastname: L'Allier
authors.affiliation: Service d'urgence, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada; Corporation d'Urgences-santé, Montreal, Quebec, Canada.
authors.forename: Eli
authors.initials: E
authors.lastname: Segal
authors.affiliation: Département multidisciplinaire de cardiologie, Institut universitaire de cardiologie et de pneumologie de Québec, Quebec, Quebec, Canada.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Rinfret
authors.affiliation: Département de médecine, Montreal Heart Institute, Montreal, Quebec, Canada.
authors.forename: Normand
authors.initials: N
authors.lastname: Racine
authors.affiliation: Département de médecine, Centre hospitalier universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Harvey
authors.affiliation: Corporation d'Urgences-santé, Montreal, Quebec, Canada; Services préhospitaliers d'urgence en Montérégie, Longueuil, Quebec, Canada; Département de médecine préhospitalière, Hôpital Sacré-Cœur de Montréal, Montreal, Quebec, Canada.
authors.forename: Dave
authors.initials: D
authors.lastname: Ross
authors.affiliation: Département de médecine d'urgence, Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis, Lévis, Quebec, Canada.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Maire
authors.affiliation: Département de cardiologie, Centre hospitalier régional de Lanaudière, Joliette, Quebec, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: Kouz
authors.affiliation: Unité d'évaluation cardiovasculaire, Institut national d'excellence en santé et en services sociaux (INESSS), Montreal, Quebec, Canada.
authors.forename: Céline
authors.initials: C
authors.lastname: Carroll
authors.affiliation: Unité d'évaluation cardiovasculaire, Institut national d'excellence en santé et en services sociaux (INESSS), Montreal, Quebec, Canada.
authors.forename: Lucy J
authors.initials: LJ
authors.lastname: Boothroyd
authors.affiliation: Centre for Clinical Epidemiology, Lady Davis Institute, Montreal, Quebec, Canada.
authors.forename: Abbas
authors.initials: A
authors.lastname: Kezouh
authors.affiliation: Unité d'évaluation cardiovasculaire, Institut national d'excellence en santé et en services sociaux (INESSS), Montreal, Quebec, Canada.
authors.forename: Leila
authors.initials: L
authors.lastname: Azzi
authors.affiliation: Unité d'évaluation cardiovasculaire, Institut national d'excellence en santé et en services sociaux (INESSS), Montreal, Quebec, Canada.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Brown
authors.affiliation: Division of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Nasmith
authors.affiliation: Unité d'évaluation cardiovasculaire, Institut national d'excellence en santé et en services sociaux (INESSS), Montreal, Quebec, Canada.
authors.forename: Laurie J
authors.initials: LJ
authors.lastname: Lambert
mesh_terms: D000368:Aged; D002423:Cause of Death / Q000639:trends; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality*; D010343:Patient Admission / Q000706:statistics & numerical data*; D011792:Quebec / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors