Abstract
ImportanceEmergency treatment options in myocardial infarction are guided by presence or absence of ST-elevations in electrocardiography. Occurrence and factors associated with ST-presentation in different population groups are however inadequately known.ObjectiveTo determine likelihood and patient features associated with ST-elevations in myocardial infarction.DesignNationwide registry study including 22 hospitals with angiolaboratory during an eight year period in Finland.SettingHospitalized care.Participants68,162 consecutive patients aged ≥30 with myocardial infarction.MeasuresLikelihood and patient features associated with presence of ST-elevations.ResultsMyocardial infarction presented with ST-elevation in 37.5% (CI 37.0–37.9%) and without in 62.5% (CI 61.9–63.1%) of patients, p<0.0001. Majority of patients aged 30–59 years with myocardial infarction had ST-elevation, but among octogenarians ST-elevations were present in only 24.7%. Presence of ST-elevations decreased with age by estimated 15.6% (CI 15.0–16.2%) per 10 year increase (p<0.0001). Men aged 40–79 years had significantly higher rate for ST-elevation myocardial infarction compared to women. Sex-based difference in presentation of myocardial infarction declined with increasing age. Overall, men had a 13% (CI 11–15%, p<0.0001) higher relative risk for ST-elevations compared to women when adjusted for age and co-morbidities. Diabetes, atrial fibrillation, peripheral or cerebral artery disease, chronic pulmonary disease, malignancy, and renal insufficiency were associated with absence of ST-elevations in myocardial infarction in multivariate analysis.Conclusions and RelevanceMyocardial infarction presents with ST-elevations more commonly in men. Presence of ST-elevations decreases with increasing age. Diabetes, atrial fibrillation, peripheral or cerebral artery disease, chronic pulmonary disease, malignancy, and renal insufficiency are associated with absence of ST-elevations in myocardial infarction. These findings may help to predict likelihood of ST-elevations in a patient with myocardial infarction.
Highlights
Emergency treatment strategies of patients with myocardial infarction (MI) are based on ST-segment presentation in electrocardiography
Men aged 40–79 years had significantly higher rate for ST-elevation myocardial infarction compared to women
Atrial fibrillation, peripheral or cerebral artery disease, chronic pulmonary disease, malignancy, and renal insufficiency were associated with absence of ST-elevations in myocardial infarction in multivariate analysis
Summary
Emergency treatment strategies of patients with myocardial infarction (MI) are based on ST-segment presentation in electrocardiography. In ST-elevation myocardial infarction (STEMI), an acute total coronary occlusion is present and immediate reperfusion therapy, preferably by primary percutaneous coronary intervention, is required [1,2]. When ST-elevations are not present, but circulating troponin levels are elevated, patient has a non-ST-elevation myocardial infarction (NSTEMI). Requiring intensive medical therapy and invasive assessment of coronary arteries should be conducted during the 24 hours [3,4]. The majority of all MI patients are known to have NSTEMI [5], factors associated with ST-presentations are less well known. We studied the likelihood of ST-segment elevation in myocardial infarction and patient features predicting it using a large multihospital registry
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