Association between time of hospitalization with acute myocardial infarction and in-hospital mortality.
Eur Heart J
; 40(15): 1214-1221, 2019 04 14.
Article
em En
| MEDLINE
| ID: mdl-30698766
ABSTRACT
AIMS:
To study the association between time of hospitalization and in-hospital mortality for acute myocardial infarction (AMI). METHODS ANDRESULTS:
Patients admitted with ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) across 243 hospitals in England and Wales between 1 January 2004 and 31 March 2013 were included. The outcome measure was in-hospital mortality. Adjusted odds ratios (ORs) for in-hospital mortality were estimated across six 4-hourly time periods over the 24-h clock using multilevel logistic regression, inverse-probability weighting propensity score, and instrumental variable analysis. Among 615 035 patients [median age 70.0 years, interquartile range 59.0-80.0 years; 406 519 (66.0%) men], there were 52 777 (8.8%) in-hospital deaths. At night, patients with NSTEMI were more frequently comorbid, and for STEMI had longer symptom-onset-to-reperfusion times. For STEMI, unadjusted in-hospital mortality was highest between 2000 and 2359 [4-h period range 8.4-9.9%; OR compared with 0000-0359 reference 1.13, 95% confidence interval (CI) 1.07-1.20], and for NSTEMI highest between 1200 and 1559 (8.0-8.8%; OR compared with 0000-0359 reference 1.07, 95% CI 1.03-1.12). However, these differences were only apparent in the earlier years of the study, and were attenuated by adjustment for demographics, comorbidities, and clinical presentation. Differences were not statistically significant after adjustment for acute clinical treatment provided.CONCLUSION:
There is little evidence to support an association between time of hospitalization and in-hospital mortality for AMI; variation in in-hospital mortality may be explained by case mix and the use of treatments.Palavras-chave
Texto completo:
1
Bases de dados:
MEDLINE
Assunto principal:
Mortalidade Hospitalar
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Infarto do Miocárdio sem Supradesnível do Segmento ST
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Infarto do Miocárdio com Supradesnível do Segmento ST
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Hospitalização
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Infarto do Miocárdio
Tipo de estudo:
Risk_factors_studies
Limite:
Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
País/Região como assunto:
Europa
Idioma:
En
Revista:
Eur Heart J
Ano de publicação:
2019
Tipo de documento:
Article
País de afiliação:
Reino Unido