Risk factors of in-hospital death in patients with acute ST elevation myocardial infarction

Coronary heart disease remains the leading cause of mortality [ 1 ]. Prevention of in-hospital death is a crucial step in improving prognosis of patients with ST elevation myocardial infarction (STEMI). We want to investigate the risk factors of in-hospital death. Totally 9668 patients with acute STEMI in Beijing Anzhen Hospital, Capital Medical University from January 2002 to August 2019. Inclusion criteria: (1) patient hospitalized with STEMI; (2) age of more than 18 years. We established the diagnosis of acute myocardial infarction (AMI) and STEMI base on fourth universal definition of myocardial infarction [ 2 ]. Exclusion criteria: none. All causes for in-hospital death is defined as cardiac or non-cardiac death during hospitalization. We selected 11 predictor variables for inclusion in our prediction rule. They were shown in Table 1 . PCI = percutaneous coronary intervention, CABG = coronary artery bypass grafting. Atrial fibrillation is defined as all type of atrial fibrillation during hospitalization. Atrioventricular block is defined as all type of atrioventricular block during hospitalization. We followed the methods of Li et al. 2019 [ 3 ]. Totally 188 patients had in-hospital death (in-hospital death group) and 9480 patients had no in-hospital death (control group). The results are shown in Table 1 . Eight variables (age, gender, history of myocardial infarction, history of hypertension, Killip classification, atrial fibrillation, atrioventricular block, and underwent PCI during hospitalization) were significant differences in the two groups of patients ( p < 0.05). After application of backward variable selection method, three variables (underwent PCI, age, and Killip classification) remained as significant independent predictors of in-hospital death. Results are shown in Tables 2 and 3 . We drew the receiver operating characteristic curve. The area under the receiver operating characteristic curve was 0.94 ± 0.007, 95% CI = 0.926–0.954. This is a single-center experience. Some patients were enrolled > 10 years ago, thus their treatment may not conform to current standards and techniques.