Predictors of Mortality in Patients Presenting with ST-segment Elevation Myocardial Infarction at Nan Hospital
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Abstract
Background: ST-segment elevation myocardial infarction (STEMI) remains a major cause of mortality, particularly in rural and resource-limited settings. This study aimed to identify predictors of in-hospital mortality among patients with STEMI admitted to Nan Hospital.
Methods: A retrospective cohort study was conducted among 312 consecutive STEMI patients admitted between October 1, 2020 and September 30, 2023. Baseline characteristics, clinical presentation, and treatment strategies were collected. Independent predictors of in-hospital mortality were identified using multivariable logistic regression analysis.
Results: The in-hospital mortality rate was 20.8%. Multivariable analysis demonstrated that increasing age (adjusted OR 1.04, 95% CI 1.00–1.07; p=0.031), delayed presentation to the emergency department >6 hours after symptom onset (adjusted OR 2.78, 95% CI 1.29–5.97; p=0.009), and cardiogenic shock (adjusted OR 4.28, 95% CI 1.05–17.49; p=0.043) were independent predictors of in-hospital mortality. Serum creatinine, systolic blood pressure, cardiac arrest at presentation, Killip class III–IV, and primary percutaneous coronary intervention were not independently associated with mortality after adjustment.
Conclusions: Older age, delayed hospital presentation, and cardiogenic shock independently predicted in-hospital mortality among STEMI patients. Strategies aimed at reducing pre-hospital delay and improving the early recognition and management of cardiogenic shock may improve clinical outcomes.
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