Predictors of In-Hospital Mortality in Patients Admitted with Acute Myocardial Infarction in a Developing Country.

Background: Limited data are available on the predictors of mortality in patients hospitalized with acute myocardial infarction (AMI) in developing countries. In this study, we analyze the predictors for in--hospital mortality in patients hospitalized with AMI (ST segment elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI)) in a large tertiary referral university hospital in Lebanon.

Methods: This was a retrospective study of 503 patients admitted to the American University of Beirut Medical Center with AMI (228 with STEMI and 275 with NSTEMI).

Results: The in-hospital mortality rate was 7.8%. The multivariate predictors of mortality in the overall population were similar to what has been reported in large registries in the USA and Europe. They included older age (> 65 years) (OR = 2.99, 95% CI = 1.22 - 7.36, P = 0.02), systolic blood pressure < 100 mm Hg (OR = 2.75, 95% CI = 1.12 - 6.76, P = 0.03), history of stroke (OR = 4.28, 95% CI = 1.29 - 14.17, P = 0.02), history of coronary artery bypass graft (CABG) (OR = 2.68, 95% CI = 1.15 - 6.23, P = 0.02), heart failure (OR = 3.92, CI = 1.62 - 9.49, P = 0.002) and ejection fraction (EF) < 35% (OR = 2.32, 95% CI = 1.05 - 5.14, P = 0.04). In a separate analysis of STEMI and NSTEMI patients, age, heart failure and a low EF continued to be multivariate predictors of mortality in both subgroups. In addition, prior stroke was an added predictor in STEMI patients, and prior CABG was an added predictor in NSTEMI.

Conclusion: Predictors of in-hospital mortality in patients hospitalized with AMI in a tertiary referral university hospital in the Middle East are similar to what has been reported in large registries in the USA and Europe.