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Mechanisms of ST Elevation Myocardial Infarction in Patients Hospitalized for Noncardiac Conditions
- Source :
- The American Journal of Cardiology. 123:1393-1398
- Publication Year :
- 2019
- Publisher :
- Elsevier BV, 2019.
-
Abstract
- ST elevation myocardial infarction (STEMI) occurring in patients hospitalized for a noncardiac condition is associated with a high mortality rate and thus we sought to determine the mechanisms underlying STEMI in this patient population. This is a single center retrospective study of 70 patients who had STEMI while hospitalized on a noncardiac service and underwent coronary angiography. Thrombotic in-hospital STEMI was defined by angiographic or intravascular imaging evidence of intracoronary thrombus, plaque rupture, or stent thrombosis. Thirty-six (51%) inpatient STEMIs developed in the operating room or various postoperative stages and 6 (9%) after endoscopy or a percutaneous procedure. Thrombotic etiologies were found in 39 (56%) patients. Nonthrombotic etiologies included vasospasm, supply-demand mismatch, and takotsubo cardiomyopathy. Patients in the thrombotic group were more likely to have antiplatelet medications discontinued on admission, had higher peak troponin levels and were more likely to undergo percutaneous coronary intervention than patients in the nonthrombotic group. Exposure to vasopressors, time from ECG to angiography, post-STEMI ejection fraction, length of stay, and in-hospital mortality were similar in both groups. There was no difference in the use of percutaneous coronary intervention in patients but longer ECG to coronary angiography times and fivefold higher in-hospital mortality in thrombotic inpatient STEMI compared with 643 patients who presented with an out-of-hospital STEMI during the same time period. In conclusion, thrombotic and nonthrombotic mechanisms cause STEMI in hospitalized patients and are associated with a high mortality.
- Subjects :
- Male
medicine.medical_specialty
Time Factors
Percutaneous
medicine.medical_treatment
Coronary Artery Disease
030204 cardiovascular system & hematology
Coronary Angiography
Risk Assessment
Electrocardiography
03 medical and health sciences
0302 clinical medicine
Risk Factors
Internal medicine
North Carolina
medicine
Humans
Hospital Mortality
cardiovascular diseases
030212 general & internal medicine
Ultrasonography, Interventional
Aged
Retrospective Studies
Inpatients
Ejection fraction
medicine.diagnostic_test
biology
business.industry
Incidence
Mortality rate
Percutaneous coronary intervention
Vasospasm
Middle Aged
medicine.disease
Troponin
Survival Rate
Treatment Outcome
surgical procedures, operative
Angiography
biology.protein
Cardiology
ST Elevation Myocardial Infarction
Female
Cardiology and Cardiovascular Medicine
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 00029149
- Volume :
- 123
- Database :
- OpenAIRE
- Journal :
- The American Journal of Cardiology
- Accession number :
- edsair.doi.dedup.....c662d62b9a7f7786c675726004593932