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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The data used used de-identified data. Therefore, IRB approval was not required. The owner of the data (The Healthcare Utilization Project) gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Available for purchase at the following link: