Key result
Prehospital mortality occurred in 2.1% of STEMI patients and was associated with female sex (OR 2.36), atypical presentation (OR 2.31), hypotension (OR 4.95), LBBB (OR 4.29), and VF (OR 2.82).
Observational (n=2,528)
Yes
Odds Ratio: 2.36 (95% CI 1.28–4.33)
In patients with STEMI, prehospital mortality is 2.1% and is strongly associated with female sex, atypical presentation, hypotension, LBBB, extensive infarction, and ventricular fibrillation.
Highlights prehospital risks in STEMI; leaves open whether targeted interventions reduce mortality.
OBJECTIVE: Hospital mortality in myocardial infarction ST-elevation myocardial infarction has decreased in recent years, in contrast to prehospital mortality. Our objective was to determine initial complications and factors related to prehospital mortality in patients with acute myocardial infarction with ST segment elevation (STEMI). METHODS: Observational study based on a prospective continuous register of patients of any age attended by out-of-hospital emergency teams in Andalusia between January 2006 and June 2009. This includes patients with acute coronary syndrome-like symptoms whose initial ECG showed ST elevation or presumably new left bundle branch block (LBBB). Epidemiological, prehospital data and final diagnostic were recorded. The study included all patients with STEMI on the register, without age restrictions. Forward stepwise logistic regression analysis was performed to control for confounders. RESULTS: A total of 2528 patients were included, 24% were women. Mean age 63.4±13.4 years; 16.7% presented atypical clinical symptoms. Initial complications: ventricular fibrillation (VF) 8.4%, severe bradycardia 5.8%, third-degree atrial-ventricular (AV) block 2.4% and hypotension 13.5%. Fifty-two (2.1%) patients died before reaching hospital. Factors associated with prehospital mortality were female sex (OR 2.36, CI 1.28 to 4.33), atypical clinical picture (OR 2.31, CI 1.21 to 4.41), hypotension (OR 4.95, CI 2.60 to 9.20), LBBB (OR 4.29, CI 1.71 to 10.74), extensive infarction (ST elevation in ≥5 leads) (OR 2.53, CI 1.28 to 5.01) and VF (OR 2.82, CI 1.38 to 5.78). CONCLUSIONS: A significant proportion of patients with STEMI present early complications in the prehospital setting, and some die before reaching hospital. Prehospital mortality was associated with female sex and atypical presentation, as pre-existing conditions, and hypotension, extensive infarction, LBBB and VF on emergency team attendance.
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Ortiz et al. (2014) conducted an observational in Acute myocardial infarction with ST segment elevation (STEMI) (n=2,528). Female sex vs. Male sex was evaluated on Prehospital mortality (OR 2.36, 95% CI 1.28-4.33). Prehospital mortality occurred in 2.1% of STEMI patients and was associated with female sex (OR 2.36), atypical presentation (OR 2.31), hypotension (OR 4.95), LBBB (OR 4.29), and VF (OR 2.82).
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