Caring of ST-elevation myocardial infarction patients in rural community hospital settings: Determinants of in-hospital mortality


Ertugrul Okuyan, Derya sokak Derya apt. No: 10 D: 6, Florya, Bakırkoy, Istanbul, Turkey. Email:


Objective: Cardiovascular disease contributes more than three quarters of all cardiovascular deaths worldwide. Adherence to myocardial infarction (MI) guidelines might not be possible in many rural hospitals. We aim to share our three-year experience in rural settings regarding to ST-elevation MI (STEMI) patients particularly by focusing on determinants of in-hospital mortality.

Methods: We retrospectively analysed our data for 559 acute STEMI patients admitted to our coronary care unit in Kastamonu city, Turkey between August 2004 and August 2007. Key demographic and clinical characteristics and data regarding symptom duration, prehospital transfer settings and insurance status were collected. Killip classes and in-hospital therapy of all patients were recorded.

Results: A total of 54 patients (9.66%) died within the hospitalisation period. Multivariate analysis revealed that advanced age > 65 years, late admission, hypotension at presentation, killip class > 2, anterior location, posterior location, lack of fibrinolysis and cardiogenic shock were independent predictors of in-hospital mortality.

Conclusions: In rural hospital settings, clinical resources and transfer facilities are limited. Therefore, improvement of early transfer and prehospital fibrinolysis capabilities should decrease mortality.