In-Hospital STEMI Associated With Delayed Reperfusion Compared to Those Presenting from the Community: Study
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USA: Researchers have found in a new study that patients who develop ST-segment elevation myocardial infarction (STEMI) while already hospitalized experience significant delays in reperfusion compared with those presenting from the community. The time from diagnostic ECG to device activation was 12 minutes longer for in-hospital STEMI cases.
These findings highlight system-level delays in recognizing and treating STEMI events occurring during hospitalization, as reported in Circulation: Cardiovascular Interventions.
STEMI most commonly presents in patients arriving at the hospital with acute chest pain, but a small proportion of cases occur in individuals who are already admitted for other medical or surgical conditions. While previous studies have suggested that in-hospital STEMI is associated with worse outcomes, contemporary large-scale data examining treatment timelines and complications have been limited. To address this gap, investigators conducted a national analysis comparing in-hospital and preadmission STEMI presentations.
The study, led by Jennifer A. Rymer, MD, MBA, MHS, from the Division of Cardiology at Duke University Hospital, Durham, North Carolina, analyzed data from the National Cardiovascular Data Registry (NCDR) Chest Pain–MI Registry between 2019 and 2022.
The following were the key findings:
- The study analyzed 112,590 patients from 670 US hospitals; 3.8% developed STEMI during hospitalization, while 96.2% presented with STEMI on admission.
- Patients with in-hospital STEMI were older (median 67 vs 63 years) and had higher rates of diabetes and congestive heart failure.
- Time from diagnostic ECG to device activation during primary PCI was significantly longer in in-hospital STEMI cases.
- Delays were also seen from catheterization lab arrival to device activation, suggesting gaps in recognition and care processes.
- In-hospital STEMI patients had higher rates of major bleeding, cardiogenic shock, and cardiac arrest.
- Mortality was markedly higher in in-hospital STEMI, with over 25% deaths versus less than 5% in preadmission STEMI.
- Even after adjustment, in-hospital STEMI remained strongly linked to increased mortality.
The authors concluded that in-hospital STEMI represents a distinct and high-risk clinical entity. Despite being in a monitored healthcare setting, these patients experience significant delays to reperfusion and suffer far worse outcomes.
The findings highlight the need for improved hospital systems to rapidly identify STEMI in admitted patients, streamline activation of cardiac catheterization teams, and reduce treatment delays. Addressing these system-level gaps could be critical to improving survival for this vulnerable patient population.
Reference: https://doi.org/10.1161/CIRCINTERVENTIONS.125.015547
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