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Charles Maynard, PhD; Elliott Lowy, PhD; John Rumsfeld, MD, PhD; Ann E. Sales, RN, PhD; Haili Sun, PhD; Branko Kopjar, MD, PhD; Barbara Fleming, MD, PhD; Robert L. Jesse, MD, PhD; Roxane Rusch, RN, MPA; Stephan D. Fihn, MD, MPH

Arch Intern Med. 2006;166:1410-1416.

Background  Most studies of the epidemiology and treatment of acute myocardial infarction (AMI) have focused on patients who experienced onset of their symptoms in the community and then presented to the hospital. There are, however, patients whose symptoms of AMI begin after hospitalization for other medical conditions. The purposes of this study were to determine the prevalence of in-hospital AMI in the Veterans Health Administration (VHA) and to compare baseline characteristics, treatments, and outcomes according to whether individuals presented with AMI or had an in-hospital AMI.

Methods  This was a retrospective cohort study of 7054 veterans who were hospitalized for AMI in 127 VHA medical centers between July 2003 and August 2004. The main outcome measure was 30-day mortality. Key covariates included age, body mass index, admission systolic blood pressure, heart rate, previous use of lipid-lowering drugs, elevated admission troponin value, prolonged and/or atypical chest pain on admission, and ST-segment elevation on the initial electrocardiogram.

Results  There were 792 patients (11.2%) who had AMI while hospitalized for other medical conditions. These patients differed substantially from those who presented to the hospital with AMI. The odds of 30-day mortality were greater in the in-hospital group (odds ratio, 3.6; 95% confidence interval, 3.1-4.3; P<.001) and remained higher after statistical adjustment (odds ratio, 2.0; 95% confidence interval, 1.7-2.4; P<.001).

Conclusion  Although most attention has been paid to patients with AMI admitted via the community emergency medical system or through the emergency department, AMI occurring during hospitalization for other medical problems is an important clinical problem.

Author Affiliations: Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Wash (Drs Maynard, Lowy, Sales, Sun, Kopjar, and Fihn); Department of Cardiology, VA Eastern Colorado Health Care System, Denver (Dr Rumsfeld); Office of Quality and Performance, US Department of Veterans Affairs, Washington, DC (Dr Fleming and Ms Rusch); and Department of Cardiology, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Va (Dr Jesse).

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