PMID- 30773247
OWN - NLM
STAT- MEDLINE
DCOM- 20200120
LR  - 20200120
IS  - 1879-1913 (Electronic)
IS  - 0002-9149 (Linking)
VI  - 123
IP  - 9
DP  - 2019 May 1
TI  - Mechanisms of ST Elevation Myocardial Infarction in Patients Hospitalized for 
      Noncardiac Conditions.
PG  - 1393-1398
LID - S0002-9149(19)30166-3 [pii]
LID - 10.1016/j.amjcard.2019.01.039 [doi]
AB  - ST elevation myocardial infarction (STEMI) occurring in patients hospitalized for 
      a noncardiac condition is associated with a high mortality rate and thus we 
      sought to determine the mechanisms underlying STEMI in this patient population. 
      This is a single center retrospective study of 70 patients who had STEMI while 
      hospitalized on a noncardiac service and underwent coronary angiography. 
      Thrombotic in-hospital STEMI was defined by angiographic or intravascular imaging 
      evidence of intracoronary thrombus, plaque rupture, or stent thrombosis. 
      Thirty-six (51%) inpatient STEMIs developed in the operating room or various 
      postoperative stages and 6 (9%) after endoscopy or a percutaneous procedure. 
      Thrombotic etiologies were found in 39 (56%) patients. Nonthrombotic etiologies 
      included vasospasm, supply-demand mismatch, and takotsubo cardiomyopathy. 
      Patients in the thrombotic group were more likely to have antiplatelet 
      medications discontinued on admission, had higher peak troponin levels and were 
      more likely to undergo percutaneous coronary intervention than patients in the 
      nonthrombotic group. Exposure to vasopressors, time from ECG to angiography, 
      post-STEMI ejection fraction, length of stay, and in-hospital mortality were 
      similar in both groups. There was no difference in the use of percutaneous 
      coronary intervention in patients but longer ECG to coronary angiography times 
      and fivefold higher in-hospital mortality in thrombotic inpatient STEMI compared 
      with 643 patients who presented with an out-of-hospital STEMI during the same 
      time period. In conclusion, thrombotic and nonthrombotic mechanisms cause STEMI 
      in hospitalized patients and are associated with a high mortality.
CI  - Copyright (c) 2019 Elsevier Inc. All rights reserved.
FAU - Tahir, Khola
AU  - Tahir K
AD  - Division of Cardiology University of North Carolina, Chapel Hill, North Carolina.
FAU - Pauley, Eric
AU  - Pauley E
AD  - Division of Cardiology University of North Carolina, Chapel Hill, North Carolina.
FAU - Dai, Xuming
AU  - Dai X
AD  - Division of Cardiology, New York-Presbyterian Medical Group-Queens, New York, New 
      York.
FAU - Smith, Sidney C Jr
AU  - Smith SC Jr
AD  - Division of Cardiology University of North Carolina, Chapel Hill, North Carolina.
FAU - Sweeney, Craig
AU  - Sweeney C
AD  - Division of Cardiology University of North Carolina, Chapel Hill, North Carolina.
FAU - Stouffer, George A
AU  - Stouffer GA
AD  - Division of Cardiology University of North Carolina, Chapel Hill, North Carolina; 
      McAllister Heart Institute, University of North Carolina, Chapel Hill, North 
      Carolina. Electronic address: rstouff@med.unc.edu.
LA  - eng
PT  - Journal Article
DEP - 20190207
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
SB  - IM
MH  - Aged
MH  - Coronary Angiography/*methods
MH  - Coronary Artery Disease/*complications/diagnosis
MH  - *Electrocardiography
MH  - Female
MH  - Follow-Up Studies
MH  - Hospital Mortality/trends
MH  - Humans
MH  - Incidence
MH  - *Inpatients
MH  - Male
MH  - Middle Aged
MH  - North Carolina/epidemiology
MH  - Retrospective Studies
MH  - Risk Assessment/*methods
MH  - Risk Factors
MH  - ST Elevation Myocardial Infarction/diagnosis/epidemiology/*etiology
MH  - Survival Rate/trends
MH  - Time Factors
MH  - Treatment Outcome
MH  - Ultrasonography, Interventional/*methods
EDAT- 2019/02/19 06:00
MHDA- 2020/01/21 06:00
CRDT- 2019/02/19 06:00
PHST- 2018/10/24 00:00 [received]
PHST- 2019/01/16 00:00 [revised]
PHST- 2019/01/21 00:00 [accepted]
PHST- 2019/02/19 06:00 [pubmed]
PHST- 2020/01/21 06:00 [medline]
PHST- 2019/02/19 06:00 [entrez]
AID - S0002-9149(19)30166-3 [pii]
AID - 10.1016/j.amjcard.2019.01.039 [doi]
PST - ppublish
SO  - Am J Cardiol. 2019 May 1;123(9):1393-1398. doi: 10.1016/j.amjcard.2019.01.039. 
      Epub 2019 Feb 7.