Mortality outside of hospitals, an integral component of death rate from acute myocardial infarction, is alarmingly high among younger patients

Abstract Backgrounds In-hospital mortality resulting from acute myocardial infarction (AMI) has been thoroughly documented in randomized trials and registries. However, a significant limitation in understanding the true prognosis of AMI is the out-of-hospital mortality. Purpose The study aims to analyse the out-of-hospital mortality of patients with AIM. Methods The analysis was computed using the National Database of Death Records data, part of the National Health Information System. Patients were defined using ICD10 identifications (I21 or I22 the main cause of death). Results The analysis encompassed all AMI-related deaths (17,783) in the Czech Republic from January 1, 2018, to December 31, 2022. The trend of AMI mortality by year was as follows: 3,989 in 2018 (3.5% of total mortality for that year), 3,793 in 2019 (3.4% of total mortality), 3,642 in 2020 (2.8%), 3,392 in 2021 (2.4%), and 2,967 in 2022 (2.5%). The data indicate a significant direction, showing a negative correlation between the proportion of deaths due to AMI and more recent years (r=-0.954, p=0.012). The proportion of patients who died outside the hospital remained consistent over the years: 52.6% (including 2.1% during transportation to the hospital) of all deaths due to AMI in 2018, 49.1% (including 2.7%) in 2019, 52.3% (including 2.0%) in 2020, 52.4% (including 2.2%) in 2021, and 49.9% (including 2.3%) in 2022. The figure illustrates the distribution of mortality by place of death across various age groups. The number of out-of-hospital deaths from AMI per 100,000 inhabitants was correlated with the proportion of inhabitants in regions with driving distances of 20, 40, and 60 minutes to primary PCI centers. The results indicate that a higher proportion of the region's population within a shorter commuting distance (≤60 min) of PCI centers correlates with a lower number of out-of-hospital deaths per 100,000 population (≤40 minutes: rs=-0.385, p=0.175; ≤60 minutes: rs=-0.376 p=0.185). Data on out-of-hospital AMI deaths (mean 1,825/year) were combined with data on hospitalized AMI patients (mean 14,113/year) to create a population-wide estimate of AMI mortality that included both patient groups (mean 15,939/year). This defined group of AMI patients has a 30-day mortality rate of 19.9%. Conclusions Out-of-hospital mortality is a crucial aspect of the total actual mortality from AMI, which remains disappointingly high. A substantial proportion of primarily younger patients die outside of hospitals, indicating that research efforts must focus on this alarming issue. The density of the network of primary PCI centers, adjusted for the region's population, reduces the risk of out-of-hospital death rates.Distribution of mortality