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Death from STEMI more likely in hospital than out

Sunday April 28, 2013
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People who suffer ST elevation myocardial infarction in the hospital are significantly more likely to die than those who have a STEMI outside the hospital, according to a study.

Researchers with the University of North Carolina School of Medicine found that for outpatients brought to UNC Hospitals for STEMI treatment, the survival rate was slightly more than 96%. For inpatients who had been hospitalized for noncardiac conditions and then suffered a STEMI, the survival rate was only 60%, according to the study, which was published in the April issue of the Journal of the American Heart Association.

Part of the difference arises from differences in patient characteristics, with those who suffer a STEMI in the hospital typically older and sicker than those who suffer such an event outside the hospital. But even after adjusting the statistical analysis to account for these characteristics, important differences in survival remained, said George A. Stouffer, MD, the studyís senior author and a professor in the UNC School of Medicine.

The researchers postulated that ED clinicians are trained to react quickly when a patient arrives with suspected STEMI. The time from arrival to treatment with angioplasty (door-to-balloon time) averages about 45 minutes at UNC Hospitals.

"In contrast, when patients who are in the hospital for a non-cardiac condition have a STEMI, the onset is not usually heralded by chest pain and thus healthcare providers may not suspect that a coronary artery has occluded," Stouffer said in a news release. "As a result, the time it takes for restoration of coronary blood flow for inpatients is much slower and more variable."

The results are based on 48 cases of STEMI among inpatients at UNC Hospitals between January 2007 and July 2011, compared with 227 patients with outpatient STEMI treated at UNC Hospitals during the same period.

UNC Hospitals received the American Heart Associationís Gold Level Performance Achievement Award in 2012 for its care of STEMI patients, according to the news release. The inpatient STEMI survival rates at hospitals that have not received such recognition may be worse.

Nationwide, there are approximately 11,000 cases of STEMI a year among hospital inpatients, which would translate into approximately 4,300 deaths based on data from this study.

Read the study: http://jaha.ahajournals.org/content/2/2/e000004.full.


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