Factors Associated with the Outcomes of ST-Elevation Myocardial Infarction Patients in the ED

Background ST-elevation myocardial infarction (STEMI) places a significant burden on the US healthcare system. However, there are gaps in our understanding of how patient demographics influence a STEMI’s risk to be admitted and the length of stay (LOS). Methods We conducted a retrospective analysis of the 2019 Nationwide Emergency Department Sample of patients with a primary diagnosis of STEMI. Multivariate regressions were used to determine factors associated with being admitted and longer length of stay (LOS). Results In 2019, 175,689 STEMI patients presented to the ED and 136,738 (77.8%) patients were admitted. Factors associated with higher risk of being admitted were coronary artery disease (OR:14.34, 95% confidence interval (CI): 12.43-16.54, p<0.001), modified Charlson Comorbidity Index (mCCI) of at least 3 (OR: 9.45, 95% CI: 7.33-12.17, p<0.001), and hyperlipidemia (OR:4.65, 95% CI:4.01-5.39, p<0.001). Black STEMI patients were less likely to be admitted than White STEMI patients (OR: 0.57, 95%CI: 0.43-0.75, p<0.001). Factors associated with a longer LOS include a mCCI of at least 3 (p<0.001), heart failure (p<0.001), and being an elderly patient (p<0.001). Black patients had a longer LOS than White patients (p<0.001). Medicaid beneficiaries were associated with a longer LOS than non-Medicaid beneficiaries (p<0.001). Conclusion Race and insurance status substantially affect a STEMI patient’s outcome in the ED.