Prognosis in patients having the diagnosis of myocardial infarction made during admission to a non-cardiology department

Abstract

Purpose: Due to atypical symptoms, discrete ECG changes and co-morbidity some patients (pts) with acute myocardial infarction (MI) are accidentally referred to non-cardiology departments. We wanted to characterize these pts and to assess their long-term mortality. For comparison MI pts admitted to the hospitals Coronary Care Unit (CCU) were also investigated. Mehtods: During a one-year period unselected pts admitted to a university hospital were studied. All pts having troponin I measured on clinical indication were included. Pts transferred from other hospitals were excluded. The diagnosis and classification of MI were according to the universal definition. Pts were followed for at least one year, and all cause mortality was registered using the National Civil Registration System Registry. Results: From January 2010 to January 2011 a total of 7230 consecutive pts were considered, and 3762 qualified for inclusion. A total of 488 pts had an acute MI and of these 115 (24%) were initially referred to non-cardiology departments. The remaining 373 pts were admitted to the CCU. MI pts in non-cardiology departments were older (mean age 80±11 vs. 69±13 years; p<0.001) and had significant more co-morbidity including heart failure, prior stroke, PAD and renal failure. The frequency of ST-elevation MIs was lower in pts from non-cardiology departments (10%) compared with CCU pts (33%) (p<0.001). During a median follow-up of 2.1 years 150 pts died. Mortality in pts from non-cardiology departments was higher than in CCU pts: 67% vs. 20% (p<0.001). ![Figure][1] Mortality in acute MI patients Conclusion: Long-term mortality in MI pts in non-cardiology departments is 3-4 times higher than in CCU pts. The reasons for this observation is multifactorial including significant differences in age, co-morbidity and MI classifications between the two groups. [1]: pending:yes