Reassess Hospital Costs and Mortality between Myocardial Infarction with and without ST-segment Elevation in a Modern Context

Abstract

Background Patients with ST-segment elevation myocardial infarction(STEMI) may have higher hospitalization cost and poorer prognosis than non-ST-segment elevation myocardial infarction (NSTEMI). This study aimed to investigate the differences in cost and mortality between STEMI and NSTEMI. Methods A single center retrospective study was conducted on 1144 patients with 758 STEMI patients and 386 NSTEMI patients from January 1, 2020 to May 30, 2023. Data were analyzed by SPSS version 22, and mortality risk factors were analyzed by multivariable logistic regression. Results STEMI patients had higher maximal troponin I(15222.5(27.18,40000.00) vs. 2731.5(10.73,27857.25), p <0.001) and lower left ventricular ejection fraction (LVEF) (56(53,59) vs. 57(55,59), p <0.001) compared to NSTEMI patients. The clinical symptoms were mainly persistent or interrupted chest pain/distress either STEMI or NSTEMI patients. While the percentage of persistent chest pain/ chest distress was higher in the STEMI group than in the NSTEMI group (79.68% vs. 54.92%). STEMI patients had a significantly higher risk of combined hypotension than the NSTEMI group (8.97% vs. 3.89%, p = 0.002). And IABP was much more frequently used in STEMI group than in NSTEMI group with statistical difference(2.90% vs. 0.52%, P = 0.015). STEMI patients have higher hospitalization costs (31667(25337.79,39790) vs. 30506.905 (21405.96,40233.75), p = 0.006) and longer hospitalization days (10(8,11) vs. 9(8,11), p = 0.001) compared to NSTEMI patients. Even though STEMI patients had higher mortality at hospital compared to NSTEMI patients, there was no statistical difference (3.56% vs. 2.07%, p = 0.167). Systolic blood pressure and NT-proBNP were risk factors for patient death (OR ≥ 1). Conclusions STEMI patients are more likely comorbid cardiogenic shock, heart failure complications with higher hospitalization costs and longer hospitalization days. And relatively more use of acute mechanical circulatory support devices such as IABP. Trial registration: The research was retrospectively registered in Chinese clinical trial registry on 22/11/2023(No. ChiCTR2300077885).