AMIS Plus, Hirschengraben 84, CH-8001 Zurich, Switzerland; Department of Cardiology, Cardiology Clinic, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland.
Cardiology Center, Klinik im Park, Seestrasse 220, CH-8027 Zurich, Switzerland.
Eur J Intern Med. 2015 Jul;26(6):414-9. doi: 10.1016/j.ejim.2015.05.011. Epub 2015 May 30.
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.
Patients enrolled in the AMIS Plus registry from 2002 to 2014 were analyzed. The main endpoint was in-hospital mortality.
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).
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.
目前仅有少数研究关注已经因其他原因住院的急性心肌梗死（AMI）患者，因此，本研究旨在比较因医疗或外科原因住院的院内发生 AMI 患者与门诊发生 AMI 患者。
对 2002 年至 2014 年 AMIS Plus 注册研究中的患者进行分析。主要终点为院内死亡率。
在 35394 例 AMI 患者中，356 例（1%）因其他疾病入院后发生院内 AMI（外科原因 175 例，非外科原因 181 例）。这些患者年龄更大（74 岁比 66 岁；P<0.001），更常为女性（35%比 27%；P<0.001），ST 段抬高型心肌梗死比例较低（35.5%比 55.5%；P<0.001），但风险更高：高血压（83%比 62%；P<0.001）、糖尿病（28%比 20%；P=0.001）、已知冠心病（54%比 35%；P<0.001），且合并症更多（Charlson 合并症指数>1 的比例为 51%比 22%；P<0.001）。与门诊发生 AMI 患者相比，这些患者接受经皮冠状动脉介入治疗的比例较低（OR 0.45；95%CI 0.36-0.57），阿司匹林（OR 0.43；95%CI 0.37-0.59）、P2Y12 抑制剂（OR 0.42；0.34-0.52）和他汀类药物（OR 0.51；95%CI 0.41-0.63）的使用率较低。院内死亡率较高（14.3%比 5.5%；P<0.001），院内发生 AMI 是院内死亡的独立预测因素（OR 2.35；95%CI 1.63-3.39；P<0.001）。
与门诊发生 AMI 患者相比，院内发生 AMI 患者的死亡风险更高。需要进一步努力以提高对住院患者发生 AMI 风险的识别，以便提供适当的治疗。
