Assessment of coronary care management and hospital mortality from ST-segment elevation myocardial infarction in the Kazakhstan population: Data from 2012 to 2015

Objective: The aim of this study was to assess and evaluate factors related to coronary care management and hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) hospitalized in the Kazakhstan County and city hospitals in which percutaneous coronary intervention (PCI) was performed during the period of 2012-2015.

Materials and methods: A total of 22,176 adult patients (18> years) with acute STEMI were hospitalized from January 2012 to December 2015. All the investigated STEMI patients underwent PCI.

Results: The mean age of STEMI patients was 61.52±11.48 years, 72.2% of the patients were male and 75.2% living in the rural regions. The mean time from hospitalization to PCI was 2104.41±5060.68min (median 95.0 and IQR 1034.5). The mean and median of time from hospitalization to PCI tended to decrease from 2747.7±5793.9min and 155.0min in 2012 to 1874.7±4759.2min and 73.5min in 2015. Among all STEMI events the percentage of patients from hospitalization to PCI within 0-59min was up to 39.0% during all study period. From 2012 to 2015, the percentage of STEMI patients with short time (0-59min) of hospitalization to PCI tended to increase in average by 11.4% per year (P=0.09). Among all STEMI patients hospital mortality from 2012 to 2015 did not change significantly and ranged from 9.0% in 2012 to 8.6% in 2015. By multiple logistic regression analysis, study years (2012), gender (female), age (60> years), time from hospitalization to PCI (60>min) and number of bed-days were statistically significant factors associated with patients' hospital mortality from STEMI with PCI.

Conclusions: The present study demonstrated that hospitalization delay in the treatment of STEMI patients in Kazakhstan population was without significant changes, meanwhile the number of patients perfused within 1h from hospitalization to PCI tended to increase during 2012-2015. The higher hospital mortality was associated with study year, female gender, older age, longer-time from hospitalization to PCI and shorter hospitalization.