Analysis of the hospitalization time impact on hospital mortality from acute myocardial infarction

Abstract

Diseases of the circulatory system and their most severe form – acute myocardial infarction (AMI) – is one of the most important problems of modern medicine due to the steady increase in morbidity, negative impact on quality of life, early disability of patients. 19.5 % of patients die from AMI, 50 % among which die 90-120 minutes after the first symptoms of the disease. The aim of the research was to analyse the impact of hospitalization on the mortality of patients with AMI and predict the risk of death in case of untimely hospitalization of this category of patients. Materials and methods. We have conducted a retrospective analysis of 876 medical records of patients diagnosed with AMI who were treated in the cardiology department of Kharkiv Regional Clinical Hospital in 2019. During the study, we have used retrospective, logical, medical and statistical methods. Odds ratios and a 95 % confidence interval were also calculated. Results and discussion. The research revealed the impact of hospitalization on the organization of medical care and hospital mortality of patients with AMI. It was found that the largest share of patients with AMI, both among the dead and those who left the hospital, were hospitalized in the period from 2 to 12 hours from the onset of the disease (49.6 % and 52.33 %, respectively), as well as in period after 24 hours – 28.00 % and 21.70 %, respectively. The largest share of patients with AMI, regardless of the time of hospitalization were persons older than 60 years. The results of the analysis showed that in the period up to 2 h from the onset of the disease, the share of hospitalized patients with more severe heart muscle damage (presence of Q wave) was 91.35 % against 8.65 % of patients with AMI without ST segment elevation. It should be noted that in almost 50 % of cases, patients with AMI without ST segment elevation were hospitalized after 24 h from the onset of the disease. At the same time, the largest share of deaths in this group of patients was observed in the hospital stay from 12 to 24 hours. According to the results of the research, risk factors for fatal outcome in AMI were identified, in particular male gender, the presence of an established ECG diagnosis of NSTEMI, conducting SKA in patients with AMI. It was also found that timely hospitalization of patients within the therapeutic window reduces the chances of hospital mortality by 52 %. Conclusions. The obtained data indicate a strong relationship between the time of hospitalization and the organization of medical care and hospital mortality of patients with AMI. It is reliably established that timely hospitalization of patients within the therapeutic window reduces the chances of hospital mortality by 52 %: HS is 0.483 (95 % CI 0.238 – 0.981), p=0.175.