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Predictors, treatment, and outcomes of STEMI occurring in hospitalized patients

  • Review Article
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From Nature Reviews Cardiology

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Key Points

  • ST-segment elevation myocardial infarction (STEMI) can occur outside of hospital (outpatient STEMI) or in hospitalized patients (inpatient STEMI)

  • Inpatient STEMI is associated with older age, a higher female:male ratio, and more comorbidities than outpatient STEMI

  • Inpatient STEMI is often associated with clinical presentations that are atypical compared with those of outpatient STEMI

  • Inpatient STEMI is associated with an in-hospital mortality 3–10-fold greater than that of outpatient STEMI

  • Primary percutaneous coronary intervention is used much less commonly and times-to-reperfusion are longer for inpatient STEMI than for outpatient STEMI

  • In addition to high-risk clinical profiles, in-hospital system delays in electrocardiogram acquisition, interpretation, and STEMI diagnosis can also contribute to unfavourable outcomes of inpatient STEMI

Abstract

ST-segment elevation myocardial infarction (STEMI) is most commonly caused by an acute thrombotic occlusion of a coronary artery. For patients in whom the onset of STEMI occurs outside of hospital (outpatient STEMI), early reperfusion therapy with either fibrinolysis or primary percutaneous coronary intervention reduces complications and improves survival, compared with delayed reperfusion. STEMI systems of care are defined as integrated groups of separate entities focused on reperfusion therapy for STEMI, generally including emergency medical services, emergency medicine, cardiology, nursing, and hospital administration. These systems of care have been successful at reducing total ischaemia time and outpatient STEMI mortality. By contrast, much less is known about STEMI that occurs in hospitalized patients (inpatient STEMI), which has unique clinical features and much worse outcomes than outpatient STEMI. Inpatient STEMI is associated with older age, a higher female:male ratio, and more comorbidities than outpatient STEMI. Delays in diagnosis and infrequent use of reperfusion therapy probably also contribute to unfavourable outcomes for inpatient STEMI.

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Figure 1: The effect of inpatient STEMI with or without PCI on in-hospital mortality11.
Figure 2: Practice, delays, and improvements in diagnosis and treatment of STEMI.

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Authors and Affiliations

  1. Division of Cardiology, University of North Carolina, Chapel Hill, 27599–7075, NC, USA

    Xuming Dai, Prashant Kaul, Sidney C. Smith Jr & George A. Stouffer

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  1. Xuming Dai
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  2. Prashant Kaul
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  3. Sidney C. Smith Jr
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  4. George A. Stouffer
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Contributions

X.D., P.K., and G.A.S. researched data for the article. All the authors contributed substantially to the discussion of content, writing the article, and reviewing and editing the manuscript before submission.

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Correspondence to George A. Stouffer.

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The authors declare no competing financial interests.

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Dai, X., Kaul, P., Smith, S. et al. Predictors, treatment, and outcomes of STEMI occurring in hospitalized patients. Nat Rev Cardiol 13, 148–154 (2016). https://doi.org/10.1038/nrcardio.2015.165

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