Minneapolis Heart Institute, Minneapolis, Minnesota.
Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.
JAMA Netw Open. 2019 Jan 4;2(1):e187348. doi: 10.1001/jamanetworkopen.2018.7348.
Studies of acute myocardial infarction (AMI) occurring outside the hospital have informed approaches to addressing risk, treatment, and patient outcomes. Similar insights for in-hospital AMI are lacking.
To determine the incidence, risk factors, and outcomes associated with in-hospital AMI.
DESIGN, SETTING, AND PARTICIPANTS: Cohort, nested case-control, and matched cohort study of patients hospitalized in US Veterans Health Administration facilities between July 2007 and September 2009. The incidence of in-hospital AMI was determined from a complete cohort of in-hospital AMI relative to the total number of inpatient admissions. From the in-hospital AMI cohort, detailed medical record review was performed on 687 cases and 687 individually matched controls. Risk factors and outcomes associated with in-hospital AMI were determined from matched comparison of in-hospital AMI cases to hospitalized controls.
Candidate risk factors for in-hospital AMI included characteristics at the time of admission and in-hospital variables prior to the index date.
In the determination of the incidence and risk factors associated with in-hospital AMI, the outcome of interest was in-hospital AMI. All-cause mortality was the main outcome of interest following in-hospital AMI.
A total of 5556 patients with in-hospital AMI (mean [SD] age, 73 [10] years; 5456 [98.2%] male) were identified among 1.3 million admissions, with an incidence of 4.27 in-hospital AMI events per 1000 admissions. Independent risk factors associated with in-hospital AMI included intensive care unit setting, history of coronary artery disease, heart rate greater than 100 beats/min, hemoglobin level less than 8 g/dL, and white blood cell count 14 000/μL or greater. Compared with the matched control group, mortality was significantly higher for patients with in-hospital AMI (in-hospital mortality, 26.4% vs 4.2%; 30-day mortality, 33.0% vs 10.0%; 1-year mortality, 59.2% vs 34.4%).
In-hospital AMI was common and associated with common cardiovascular risk factors and markers of acute illness. Patient outcomes following in-hospital AMI were poor, with 1-year mortality approaching 60%. Further study of in-hospital AMI may yield opportunities to reduce in-hospital AMI risk and improve patient outcomes.
对院外发生的急性心肌梗死（AMI）的研究为评估风险、治疗和患者预后提供了依据。但对于院内 AMI 缺乏类似的深入了解。
确定院内 AMI 的发生率、危险因素和结局。
设计、地点和参与者：这是一项在美国退伍军人健康管理局（Veterans Health Administration）机构住院患者中进行的队列、巢式病例对照和匹配队列研究。通过院内 AMI 相对住院人数的完整队列来确定院内 AMI 的发生率。从院内 AMI 队列中，对 687 例病例和 687 例单独匹配的对照进行详细的病历回顾。通过匹配院内 AMI 病例与住院对照，确定与院内 AMI 相关的危险因素和结局。
与院内 AMI 相关的候选危险因素包括入院时的特征和索引日期前的院内变量。
在确定与院内 AMI 相关的发生率和危险因素时，感兴趣的结局是院内 AMI。院内 AMI 后的全因死亡率是主要观察结局。
在 130 万例住院患者中，共确定了 5556 例院内 AMI（平均[标准差]年龄为 73[10]岁；5456[98.2%]为男性），院内 AMI 的发生率为每 1000 例住院患者中有 4.27 例。与院内 AMI 相关的独立危险因素包括重症监护病房环境、冠状动脉疾病史、心率大于 100 次/分、血红蛋白水平小于 8g/dL 和白细胞计数大于等于 14000/μL。与匹配对照组相比，院内 AMI 患者的死亡率显著更高（院内死亡率 26.4%比 4.2%；30 天死亡率 33.0%比 10.0%；1 年死亡率 59.2%比 34.4%）。
院内 AMI 很常见，与常见的心血管危险因素和急性疾病标志物有关。院内 AMI 后的患者预后较差，1 年死亡率接近 60%。对院内 AMI 的进一步研究可能为降低院内 AMI 风险和改善患者预后提供机会。
