Key Points
- To identify clinical characteristics and factors that affect in-hospital mortality among patients admitted with acute myocardial infarction.
- Conducted a retrospective analysis of 555 consecutive acute myocardial infarction patients (mean age 61.3 years; 69.7% male) admitted to a hospital in Korea between January 1990 and May 1997.
- Stratified patients into non-survivors who died during hospitalization (n=85, 15.3%) and survivors discharged alive (n=470, 84.7%) to compare clinical profiles, Killip classification, and causes of death over time.
- Non-survivors were significantly older (mean 65.4 vs. 60.5 years), had a higher proportion of females (43% vs. 28%), lower blood pressure (108/65 vs. 125/76 mmHg), and presented with higher Killip classes (Killip IV: 30.6% vs. 4.3%).
- Over half of all deaths (47 patients) occurred on the first hospital day, with cardiogenic shock serving as the leading cause of death overall (31%) and within the first week, while congestive heart failure became the predominant cause after one week.
- The primary mechanism of death differed by baseline clinical severity, presenting as ventricular tachycardia or fibrillation in Killip class I patients and cardiogenic shock in Killip classes II–IV.
Structured PICO
PPopulation555 consecutive patients with acute myocardial infarction (AMI) admitted to Dong-San Medical Center from January 1990 to May 1997, mean age 61.3 years, 69.7% male.
OOutcomeIn-hospital mortality and causes of deathhard clinical
In-hospital mortality for acute myocardial infarction remains significant, driven primarily by cardiogenic shock in the first week, highlighting the need for rapid intervention in high-risk patients such as the elderly and those with high Killip class.
Limitations
- Retrospective study design
- Exact cause of death unknown in 8 patients
- Difficulty in obtaining lab results for patients who died in the ER
- Potential underestimation of mortality due to sudden death before arrival