In-hospital mortality in acute ST-elevation myocardial infarction: prevalence and associated predictors

Background

Acute coronary syndromes are among the most common cardiovascular emergencies, associated with high mortality and morbidity. ST-elevation myocardial infarction (STEMI) remains a leading cause of in-hospital death, despite advances in reperfusion therapy and early management protocols(1–4).

Purpose

To identify clinical factors, comorbidities and procedural factors associated with in-hospital mortality in patients with STEMI.

Methods

Observational, retrospective, single-center study that included all patients admitted with STEMI between September 2023 and September 2025, in a tertiary hospital.

Results

A total of 247 patients admitted with STEMI were included, 77.7% male and 22.3% female. Overall in-hospital mortality was 10.5%. Regarding cardiovascular risk factors, 25.1% had diabetes, 67.6% dyslipidemia, 57.9% hypertension, and 38.1% were active smokers, with an additional 19% being former smokers. Diabetes (OR = 5.048; 95% CI 2.175–11.718; p<0,001) and hypertension (OR = 2.656; 95%; CI 1.027–6.868; p=0.038) were significantly associated with a higher mortality. Active smoking, conversely, was associated with lower in-hospital mortality (p=0.042).

Concerning myocardial territory involvement, in the overall cohort, 59.9% presented inferior wall involvement, 29.6% anterior wall involvement, and 23.5% lateral wall involvement; none of these territories showed a significant association with in-hospital mortality. Presentation with cardiac arrest was also associated with a worse outcome (62.5% mortality; p<0.001). Patients with reduced LVEF on echocardiography had significantly worse outcomes (p=0.008).

Regarding ischemic timing, door-to-catheterization times were slightly longer in diabetic patients, although not statistically significant (59 vs 72 min; p=0.226). Activation of coronary emergency pathway in triage was associated with lower mortality rates (OR = 0.151; 95% 0.064-0.356; p<0.001). Patients who were triaged through this pathway had significantly shorter door-to-catheterization times (54 min vs 163 min; p<0.001). Other time variables, including total ischemic time and ECG-to-catheter lab time were not significantly associated with mortality (p=0.647 and p=0.338 respectively).

Conclusion

Our findings revealed that cardiovascular risk factors, reduced LVEF and cardiac arrest were deleterious factors for in-hospital mortality in STEMI patients. Early activation of coronary emergency pathway protocol was strongly protective, being a crucial factor in reducing death.