Details

Autor(en) / Beteiligte

• Erne, Paul
• Bertel, Osmund
• Urban, Philip
• Pedrazzini, Giovanni
• Lüscher, Thomas F
• Radovanovic, Dragana

Titel

Inpatient versus outpatient onsets of acute myocardial infarction

Ist Teil von

• European journal of internal medicine, 2015-07, Vol.26 (6), p.414-419

Ort / Verlag

Netherlands: Elsevier B.V

Erscheinungsjahr

2015

Quelle

ScienceDirect

Beschreibungen/Notizen

• Abstract Background 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. Methods Patients enrolled in the AMIS Plus registry from 2002 to 2014 were analyzed. The main endpoint was in-hospital mortality. Results 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). Conclusions 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.