University of California Los Angeles, Los Angeles, California, USA.
University of North Carolina, Chapel Hill, North Carolina, USA.
Clin Cardiol. 2020 Dec;43(12):1555-1561. doi: 10.1002/clc.23480. Epub 2020 Nov 7.
In-hospital ST-elevation myocardial infarction (STEMI) is associated with a higher mortality rate than out-of-hospital STEMI. Quality measures and universal protocols for treatment of in-hospital STEMI do not exist, likely contributing to delays in recognition and treatment.
To analyze differences in mortality among three subsets of patients who develop in-hospital STEMI.
This was a multicenter, retrospective observational study of patients who developed in-hospital STEMI at six United States medical centers between 2008 and 2017. Patients were stratified into three groups: (1) cardiac, (2) periprocedure, or (3) noncardiac/nonpostprocedure. Outcomes examined include time from electrocardiogram (ECG) acquisition to cardiac catheterization lab arrival (ECG-to-CCL) and survival to discharge.
We identified 184 patients with in-hospital STEMI (mean age 68.7 years, 58.7% male). Group 1 (cardiac) patients had a shorter average ECG-to-CCL time (69 minutes) than group 2 (periprocedure, 215 minutes) and group 3 (noncardiac/nonpostprocedure, 199 minutes). Compared to group 1, survival to discharge was lower for group 2 (OR 0.33, P = .102) and group 3 (OR 0.20, P = .016). After adjusting for prespecified covariates, the relationship between group and survival showed a similar trend but did not reach statistical significance.
Patients who develop in-hospital STEMI in the context of a preceding procedure or noncardiac illness appear to have longer reperfusion times and higher in-hospital mortality than patients admitted with cardiac diagnoses. Larger studies are warranted to further investigate these observations. Health systems should place an increased emphasis on developing quality metrics and implementing quality improvement initiatives to improve outcomes for in-hospital STEMI.
与院外 ST 段抬高型心肌梗死（STEMI）相比，院内 STEMI 患者的死亡率更高。目前尚无针对院内 STEMI 的治疗质量措施和通用方案，这可能导致对其识别和治疗的延误。
分析在院内发生 STEMI 的 3 组患者的死亡率差异。
这是一项在美国 6 家医疗中心进行的多中心、回顾性观察性研究，研究对象为 2008 年至 2017 年期间在院内发生 STEMI 的患者。患者被分为 3 组：（1）心脏组，（2）围手术期组，或（3）非心脏/非术后组。观察的结局包括从心电图（ECG）采集到心导管实验室到达（ECG-CCL）的时间以及出院时的存活情况。
我们共纳入了 184 例院内 STEMI 患者（平均年龄 68.7 岁，58.7%为男性）。与组 2（围手术期组，215 分钟）和组 3（非心脏/非术后组，199 分钟）相比，组 1（心脏组）患者的平均 ECG-CCL 时间更短（69 分钟）。与组 1 相比，组 2（OR 0.33，P =.102）和组 3（OR 0.20，P =.016）的出院时存活率较低。在校正了预设协变量后，组与生存率之间的关系仍呈相似趋势，但未达到统计学意义。
与心脏疾病入院的患者相比，在先前的手术或非心脏疾病背景下发生院内 STEMI 的患者似乎具有更长的再灌注时间和更高的院内死亡率。需要开展更大规模的研究来进一步探究这些观察结果。医疗体系应更加重视制定质量指标并实施质量改进计划，以改善院内 STEMI 的治疗结局。
