Mortality Rates and Length of Stay in Patients With Acute Non-ST Segment Elevation Myocardial Infarction Hospitalized for Noncardiac Conditions on Surgical Versus Nonsurgical Services

Patients hospitalized for noncardiac conditions often experience increased levels of stress and hemodynamic challenges, making them susceptible to acute coronary events. The clinical features, management strategy, and outcomes of inpatient non-ST segment elevation myocardial infarction (NSTEMI) have not been described. This single-center retrospective study identified patients with inpatient NSTEMI from the University of North Carolina Hospitals discharge database in February 2008 to April 2014 using International Classification of Diseases, Ninth Revision (ICD-9) codes. This process generated an initial list of 485 cases that were subsequently manually reviewed. The associations of cardiac catheterization with in-hospital mortality and length of stay were analyzed using multivariable logistic regression and multiple linear regression. A total of 302 patients were confirmed to have inpatient NSTEMI, with 154 patients admitted to surgical and 148 admitted to nonsurgical services. The in-hospital mortality rate of patients with inpatient NSTEMI was high (19%). Patients with inpatient NSTEMI who underwent cardiac catheterization had lower in-hospital mortality rates than those who did not undergo cardiac catheterization (6% vs 25%; adjusted odds ratio 0.19, 95% confidence interval 0.07 to 0.50) and were discharged 6.8 days earlier (95% confidence interval 2.3 to 11.2 days). Inpatient NSTEMIs on surgical services compared with nonsurgical services were more likely to generate cardiology consultation (96% vs 62%, p <0.0001) and left heart catheterization (41% vs 24%, p = 0.002), with similar rates of revascularization (56% vs 56%, p = 1.0). In conclusion, both nonsurgical and surgical patients with inpatient NSTEMI who underwent invasive management had lower in-hospital mortality rates and shorter lengths of stay.