Comparison Between In-Hospital Outcome of Patients with Acute ST-Elevation Myocardial Infarction and Non-ST-Elevation Myocardial Infarction
TL;DR
Although overall in-hospital outcomes were broadly comparable between STEMI and NSTEMI patients, STEMI was associated with a higher incidence of cardiogenic shock, impaired left ventricular function and longer hospitalization.
Abstract
Background: Acute myocardial infarction (AMI) remains a major cause of morbidity and mortality worldwide. AMI is broadly classified into ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI), which differ in pathophysiology, clinical presentation, management and prognosis. This study aimed to compare the in-hospital outcomes of patients with acute STEMI and NSTEMI. Methods: This prospective observational study was conducted in the Department of Cardiology, Chittagong Medical College Hospital, Bangladesh. A total of 100 patients with acute myocardial infarction were enrolled, including 50 STEMI patients (Group A) and 50 NSTEMI patients (Group B). Patients were selected according to WHO diagnostic criteria for myocardial infarction. Demographic characteristics, cardiovascular risk factors, clinical parameters, echocardiographic findings in-hospital complications, duration of hospital stay and mortality were analyzed. Statistical analysis was performed using SPSS and a p-value <0.05 was considered statistically significant. Results: The mean age was 49.98±11.90 years in the STEMI group and 51.90±8.58 years in the NSTEMI group (p=0.357). Male predominance was significantly higher in the STEMI group (94% vs. 68%, p=0.001). Smoking (84% vs. 62%, p=0.013) and dyslipidemia (64% vs. 40%, p=0.016) were significantly more common among STEMI patients, whereas obesity was more prevalent in NSTEMI patients (54% vs. 32%, p=0.026). Cardiogenic shock occurred significantly more frequently in STEMI patients (12% vs. 0%, p=0.012). Left ventricular systolic function was significantly lower in STEMI patients with mean ejection fraction of 50.96±9.82% compared with 55.50±11.30% in NSTEMI patients (p=0.035). STEMI patients had a longer hospital stay (5.02±0.82 vs. 4.34±0.66 days, p<0.001). No significant differences were observed regarding arrhythmias, congestive heart failure, pericardial effusion, hypotension, ventricular septal rupture or in-hospital mortality. Conclusion: Although overall in-hospital outcomes were broadly comparable between STEMI and NSTEMI patients, STEMI was associated with a higher incidence of cardiogenic shock, impaired left ventricular function and longer hospitalization. Early identification and intensive monitoring of STEMI patients may help reduce adverse in-hospital outcomes and improve prognosis.