This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Zahn, R. Search for Related Content PubMed PubMed Citation Articles by Zahn, R.

CLINICAL STUDIES

Acute myocardial infarction occurring in versus out of the hospital: patient characteristics and clinical outcome

Ralf Zahn, MD^*, Rudolf Schiele, MD^a, Karlheinz Seidl, MD^a, Thomas Kapp, MD^*, Hans Georg Glunz, MD, Edwin Jagodzinski, MD, Thomas Voigtländer, MD, Martin Gottwik, MD^||, Gunther Berg, MD^¶, Helmut Thomas, MD^#, Jochen Senges, MD^a for the Maximal Individual TheRapy in Acute Myocardial Infarction (MITRA) Study Group

^a Herzzentrum Ludwigshafen, Bad Dürkheim, Germany
^* Vincentius Krankenhaus Speyer, Bad Dürkheim, Germany
Westpfalz-Klinikum Kaiserslautern, Bad Dürkheim, Germany
Marienkrankenhaus Ludwigshafen, Bad Dürkheim, Germany
Johannes Gutenberg Universität Mainz, Bad Dürkheim, Germany
^|| Klinikum Nürnberg, Bad Dürkheim, Germany
^¶ Universitätsklinikum Homburg/Saar, Bad Dürkheim, Germany
^# Evangelisches Krankenhaus, Bad Dürkheim, Germany

Manuscript received October 8, 1999; revised manuscript received December 16, 1999, accepted February 9, 2000.

Reprint requests and correspondence: Dr. Ralf Zahn, Herzzentrum Ludwigshafen, Department of Cardiology, Bremserstrasse 79, D-67063 Ludwigshafen, Germany
erzahn{at}aol.com

OBJECTIVES

We describe the baseline characteristics and clinical course of patients who had an acute myocardial infarction (AMI) during their hospital stay.

BACKGROUND

In comparison with patients who had an AMI outside of the hospital (prehospital AMI), the data on patients who had an AMI in the hospital are poorly described.

METHODS

Patients with an in-hospital AMI were prospectively registered in the Southwest German Maximal Individual TheRapy in Acute myocardial infarction (MITRA) study and compared with patients with prehospital AMI.

RESULTS

Of 5,888 patients with AMI, 403 patients (6.8%) had an in-hospital AMI. These patients were older, more often male and sicker as compared with the patients with a prehospital AMI. They also showed a higher prevalence of concomitant diseases, such as arterial hypertension, diabetes mellitus, renal insufficiency and contraindications for thrombolysis. There was no significant difference regarding the use of reperfusion therapy, either thrombolysis (in-hospital AMI 44.2% vs. prehospital AMI 49.1%; odds ratio [OR] 0.86, 95% confidence interval [CI] 0.70 to 1.05) or primary angioplasty (9.9% vs. 8.2%; OR 1.23, 95% CI 0.88 to 1.73), or a combination of both, between the two groups. The interval from symptom onset to the start of treatment in patients receiving reperfusion therapy was 55 min for patients with an in-hospital AMI versus 180 min for patients with a prehospital AMI (p = 0.001). In-hospital death occurred in 110 (27.3%) of 403 patients with an in-hospital versus 762 (13.9%) of 5,485 patients with a prehospital AMI (OR 2.33, 95% CI 1.85 to 2.94). This was confirmed by logistic regression analysis after adjusting for other confounding variables (OR 1.67, 95% CI 1.23 to 2.24).

CONCLUSIONS

In-hospital AMI occurred in 6.8% of patients. Time to intervention was shorter; however, the use of reperfusion therapy for in-hospital AMI was not different from that for prehospital AMI. In particular, primary angioplasty seems to be underused in these patients. This, as well as the selection of patients, may result in the high hospital mortality rate of 27.3%.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CI = confidence interval   ECG = electrocardiogram   MITRA = Maximal Individual TheRapy in Acute myocardial infarction study   MONICA = Multinational MONitoring of Trends and Determinants in CArdiovascular Disease   OR = odds ratio

This article has been cited by other articles:

				C. Maynard, E. Lowy, J. Rumsfeld, A. E. Sales, H. Sun, B. Kopjar, B. Fleming, R. L. Jesse, R. Rusch, and S. D. Fihn The prevalence and outcomes of in-hospital acute myocardial infarction in the department of veterans affairs health system. Arch Intern Med, July 10, 2006; 166(13): 1410 - 1416. [Abstract] [Full Text] [PDF]