Abstract 108: Contemporary Timing and Etiology of Mortality in ST-Elevation Myocardial Infarction

Abstract

Background: Acute treatment of ST-elevation myocardial infarction (STEMI) has focused on early reperfusion, prompt defibrillation, and appropriate mechanical support to mitigate short-term mortality. Long-term patterns of death in a contemporary population are not well described. Methods: We reviewed consecutive cases of STEMI treated with percutaneous coronary intervention (PCI) at our center between January 1, 2011, and December 31, 2016, and divided patients into two groups: uncomplicated STEMI (US) and complicated STEMI (CS). CS was defined by presence of cardiac arrest or cardiogenic shock, ascertained from first-medical-contact to device time for PCI. We assessed for differences in characteristics and short- and long-term mortality between the groups. Results: We identified 1,272 patients with STEMI; 214 of which were CS (16.8%). Those with CS were significantly more likely to have heart failure (22.9% vs 11.3%, p<0.001), kidney disease (38.2% vs. 21.0%, p<0.001), cerebrovascular disease (18.7% vs 11.0%, p=0.003), peripheral vascular disease (16.8% vs 7.9%, p<0.001), and left main or left anterior descending culprit vessel (51.9% vs. 40.3%, p<0.002). Total in-hospital mortality was 5.0% (63 patients), with 19.6% (42/214) and 2.0% (21/1058) of those with CS and US respectively (p<0.001). Among 1209 of patients that survived to hospital discharge, total long-term mortality was 10% (121 patients) of which 18.0% (31/172) had CS and 8.7% (90/1037) had US (p=0.001) over mean follow-up of 3.1±1.9 years. Of those, 52% and 50%, respectively, were from non-cardiovascular etiologies (Figure) including malignancy (13% vs. 22%), infection (22% vs. 19%), or other causes (17% vs. 9.0%). Conclusion: Despite advances in the in-hospital care of patients with STEMI, there remains a significant risk of long-term mortality for both patients with uncomplicated and complicated STEMI. A substantial proportion of overall STEMI mortality now occurs after hospital discharge predominantly due to non-cardiovascular causes. Systems of care to mitigate this long-term risk are needed.