Single-center Analysis Of Diagnoses And Treatments In Patients With Acute ST-Elevation Myocardial Infarction Who Hospitalized For Noncardiac Conditions

Objective: There are a lot of studies on treatment paths of acute ST-elevation myocardial infarction(STEMI), which have formed a mature standardized guideline. But research data are mainly from STEMI patients in cardiac department, while research on diagnosis, treatment and clinical prognosis of patients with STEMI hospitalized for a noncardiac condition is rare. This paper retrospectively observed the clinical diagnosis and treatment of STEMI in patients hospitalized for a noncardiac condition, aiming to explore the standardized emergency management paths of this part of patients.Methods: A retrospective analysis was carried out, with 40 cases of STEMI inpatients from non-cardiac department in Shanghai Tenth People’s Hospital between January 2005 and December 2014 as the observation group, and 40 cases of patients who were diagnosed as STEMI in emergency or outpatient and were admitted in cardiac department were randomly selected in the same time period as the control group. The two groups of patients were compared for general, diagnosis and treatment.Results:(1) Patients of the observation group were elder, and had a high proportion combined with CVA/TIA(P=0.025), a higher rate of history of CAD(P=0.021), and an even greater percentage of oral administration of second-line prevention drugs before admission(aspirin(P=0.043), aspirin + clopidogrel/ticagrelor(P=0.029), β-receptor blockers(P=0.050), and statins(P=0.002));(2) ECG obtain time of the observation group and control group were(64.2[42.3,86.0]min vs. 7.7[6.6,8.7]min, P<0.0001); and the duration from ECG acquisition to transferring to cardiac catheterization laboratory of the observation group of control group were(120.4[79.4,161.5]min vs. 55.5[40.2,70.8]min, P<0.0001); rate of PCI of the observation group and control group were(55% vs. 95%,P<0.001);(3) Acute mortality of the observation group and control group were(37.5% vs. 5%, P<0.001); Multivariable Logistic regression analysis suggested: delay of ECG obtain time(OR:1.332,95 % CI[1.009,1.757 ], P=0.043), absence of CAG(OR: 0.109,95 %CI[0.053,0.797], P=0.012), and PCI(OR:0.154,95 % CI[0.020,0.913], P=0.007) were independent risk factors of death in STEMI inpatients from non-cardiac department.Conclusions: STEMI inpatients from non-cardiac department have higher mortality rate, relatively lower interventional operation rate, elder age, and more complications; absence of interventional operation isassociated with death of inpatients; shortening the ECG obtain time, and time from admission to transferring to catheterization laboratory can improve the survival of these patients.