Can the in-hospital mortality rate in patients with ST-elevation myocardial infarctions be lowered any further?

BACKGROUND A myocardial infarction is a specific clinical condition characterized by a relatively high acute mortality rate. Earlier reperfusion results in a smaller infarct size and a lower mortality rate. OBJECTIVES To assess the in-hospital mortality in patients with ST-elevation myocardial infarction (STEMI) regarding patients' characteristics, and the mechanisms behind the deterioration in hemodynamic and clinical status, in order to assess the possibility of preventing this type of death. MATERIAL AND METHODS A group of 106 patients aged 64.5 ±11.3 years was divided into 2 groups: patients who died while hospitalized (group I; n = 5) and patients who survived while hospitalized for STEMI (group II; n = 101). Primary coronary intervention was performed in all individuals, with direct stent implantation in all but 1 patient. In all patients the standard medication was started or continued, depending on the patient's status. The demographic and selected clinical and biochemical parameters were compared between the study groups. RESULTS The patients in group I were significantly older than the survivors (76.2 ±12.7 compared to 64.0 ±11.0 years; p < 0.05). The group with fatal myocardial infarction had a lower left ventricular ejection fraction (LVEF) (31.7 ±12.8% compared to 60.4 ±11.0%; p < 0.05) and a higher maximal serum troponin level (973.6 ±1121.8 ng/mL compared to 453.2 ±924.2 ng/mL; p < 0.05). Interestingly, among the patients who died, the pain-to-balloon time was significantly shorter than in the myocardial infarction survivors (84 ±48 min compared to 342 ±504 min; p < 0.05). CONCLUSIONS The development of the medical care system has made invasive procedures available, improving outcomes in patients with acute myocardial infarction. This form of treatment is likely optimized to such an extent that any changes in the time before intervention will not substantially improve mortality rates.