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Adverse Outcomes in Hospitalized Patients Who Develop ST-elevation Myocardial Infarction

Richmond, Tyler MD*; Holoshitz, Noa MD; Haryani, Anand BA; Purim-Shem-Tov, Yanina MD; Sharma, Gaurav MD; Schaer, Gary L. MD

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine:
doi: 10.1097/HPC.0000000000000009
Original Articles

Background: There has been considerable emphasis on the care of patients with ST-elevation myocardial infarction (STEMI) with the wide implementation of protocols to quickly identify and triage them from the emergency department (ED) to a cardiac catheterization laboratory for percutaneous coronary intervention. However, a small but important number of patients with STEMI develop ST-elevation while hospitalized for another medical problem.

Methods: A single-center, retrospective chart review was performed on 172 consecutive patients with STEMI who underwent emergency percutaneous coronary intervention. One hundred thirty-seven patients presenting to the ED with STEMI and 35 patients who developed STEMI while hospitalized were compared.

Results: Hospitalized patients with STEMI had delayed reperfusion, longer hospitalization, greater rates of stent thrombosis, and greater 30-day and 1-year mortality compared with these in patients presenting with STEMI to the ED.

Conclusions: Optimized clinical pathways for prevention, early diagnosis, and expedited reperfusion of inpatients with STEMI are urgently needed.

Author Information

From the *Central Baptist Heart and Vascular Institute, Lexington, KY; Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL; and Department of Emergency Medicine, Rush University Medical Center, Chicago, IL.

Reprints: Gary L. Schaer, MD, Division of Cardiology, Rush University Medical Center, 1653 West Congress Parkway, Suite 1035 Jelke, Chicago, IL 60612. E-mail:

© 2014 by Lippincott Williams & Wilkins