Internal and Emergency Medicine最新文献

{"title":"Nonlinear relationship between rheumatoid arthritis disease duration and lung cancer risk in a Chinese cohort: a threshold effect study.","authors":"Jianbin Li, Suiran Li, Xiaoqing Wang, Wei Liu","doi":"10.1007/s11739-026-04406-x","DOIUrl":"10.1007/s11739-026-04406-x","url":null,"abstract":"<p><p>Patients with rheumatoid arthritis (RA) face an increased risk of lung cancer, yet the pattern of association between disease duration and lung cancer risk remains unclear. This study aimed to investigate the time-dependent relationship between RA disease duration and lung cancer risk, identifying potential nonlinear associations and clinical risk thresholds. This single-center retrospective cohort study included 4736 RA patients meeting the 2010 ACR/EULAR criteria who attended the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine between January 2014 and December 2024. Restricted cubic spline analysis was used to identify the inflection point, based on which patients were stratified into disease duration < 10 years and ≥ 10 years groups. One-to-one propensity score matching (PSM) was performed to balance baseline age, sex, hypertension, diabetes, and hyperlipidemia, resulting in 3942 matched patients for final analysis. The primary outcome was lung cancer confirmed by histopathology or imaging. Multivariable logistic regression was used to analyze associated factors, and restricted cubic splines evaluated the nonlinear relationships between RA disease duration, age, and lung cancer risk. In the matched cohort, 72 patients (1.83%) developed lung cancer. The incidence was 2.59% (51 cases) in the ≥ 10 years group, significantly higher than 1.07% (21 cases) in the < 10 years group (p = 0.001). Multivariable analysis showed that RA disease duration of ≥ 10 years was significantly associated with lung cancer risk (adjusted OR 2.36, 95% CI 1.27-4.37, p = 0.007). Restricted cubic spline analysis revealed a significant nonlinear relationship between RA disease duration and lung cancer risk, with risk beginning to increase notably when disease duration reached approximately 10 years. Age also showed a nonlinear association with lung cancer risk, with an accelerated risk increase after 63 years. RA disease duration ≥ 10 years is significantly associated with increased lung cancer risk, exhibiting a clear nonlinear growth pattern. Given the retrospective design and the absence of smoking data, these findings should be regarded as hypothesis-generating rather than practice-changing, and prospective validation is required before more intensive lung cancer surveillance can be recommended for RA patients with prolonged disease duration.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"2153-2163"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148137567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Local LLM-based sentiment analysis of emotional patterns in complex-to-manage and treatment-resistant psoriatic arthritis.","authors":"Vincenzo Venerito, Sergio Del Vescovo, M Cameron Hay, Shikha Singla, Christine Lindsay, Philip Judson Mease, Fabian Proft, Andre Lucas Ribeiro","doi":"10.1007/s11739-026-04396-w","DOIUrl":"10.1007/s11739-026-04396-w","url":null,"abstract":"<p><p>Psoriatic arthritis (PsA) presents significant challenges, with many patients experiencing inadequate treatment response. While clinical aspects of suboptimal disease control have been characterized, the emotional burden of treatment failure remains poorly understood. Our objective was to systematically characterize the emotional patterns expressed by PsA patients when describing treatment failures and management challenges. A multi-national online survey with PsA patients was conducted through GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis). The survey was conducted to explore their perspectives on how to define complex-to-manage (C2M)-PsA and treatment-refractory (TR-) PsA, and how these conditions impact their lives. Open-ended responses were analyzed using a locally deployed Meta Llama 3.2 3B Instruct large language model, applying Ekman's six basic emotion framework and the valence-arousal dimensional model. Sentiment analysis revealed predominantly negative emotional patterns (mean valence -0.57 ± 0.25) with moderate-to-high arousal (0.65 ± 0.10). Sadness was most prevalent (54.27%), followed by fear (43.59%). Disease duration (≥ 5 years) showed similar valence scores to shorter durations. The number of reported challenging disease aspects negatively correlated with valence (r = -0.16, p = 0.02) and positively with fear (r = 0.15, p = 0.02). Axial involvement and comorbidities were significantly associated with fear as the dominant emotion. Hierarchical clustering identified four distinct emotional profiles, with high multi-domain burden clusters showing the most negative valence. Natural language processing-based sentiment analysis characterizes emotional patterns in PsA patient narratives. Negative emotions, particularly sadness and fear, predominated, with specific disease features linked to these emotional states, underscoring the need for approaches addressing both physical and emotional dimensions in PsA.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"2121-2132"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148194720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategies for therapeutic optimization and proactive care in chronic obstructive pulmonary disease (COPD): an Italian expert opinion.","authors":"Paola Rogliani, Massimo Andreoni, Francesco Dentali, Claudio Micheletto, Andrea Montagnani, Nicola Montano, Alberto Papi, Alessandro Rossi, Pierachille Santus","doi":"10.1007/s11739-026-04479-8","DOIUrl":"10.1007/s11739-026-04479-8","url":null,"abstract":"<p><p>Chronic obstructive pulmonary disease (COPD) remains a major public health challenge, characterized by substantial underdiagnosis, high morbidity and mortality, and significant healthcare burden. In Italy, the gap between estimated and diagnosed prevalence highlights the need for improved early detection and proactive management. This expert opinion, developed by a multidisciplinary panel, translates current evidence into practical recommendations tailored to the Italian healthcare context. Patient characterization has moved from a spirometry-centered approach to a proactive, multidimensional model integrating symptom burden, exacerbation history, and cardiopulmonary risk. Early diagnosis should be driven by structured case-finding in primary care and internal medicine, using spirometry for confirmation. Early identification of uncontrolled patients relies on standardized tools, including symptom quantification (CAAT score) and indirect markers like recurrent antibiotic or oral corticosteroid use. Exacerbations are critical events that accelerate both pulmonary and cardiovascular deterioration, identifying a high-risk phase requiring prompt reassessment and optimization. In this context, single-inhaler triple therapy (SITT) is the only pharmacological strategy consistently associated with reduced exacerbations and all-cause mortality in high-risk populations. Timely SITT use may also reduce cardiopulmonary risk. Furthermore, preventing exacerbations limits antibiotic and systemic corticosteroid use, promoting antimicrobial stewardship and mitigating resistance. This expert opinion emphasizes the need for integrated care pathways, standardized clinical tools, and multidisciplinary coordination to overcome therapeutic inertia. A shift toward early identification, timely intervention, and prevention-oriented strategies is essential to improve outcomes and reduce the systemic burden of COPD.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1945-1953"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tilt testing or implantable cardiac monitoring in the diagnosis of unexplained syncope.","authors":"Alessandra Rabajoli, Derek Chew, Joshua Szaszkiewicz, Satish Raj, Marlon Cua, Carlos Morillo, Robert Sheldon","doi":"10.1007/s11739-025-04128-6","DOIUrl":"10.1007/s11739-025-04128-6","url":null,"abstract":"<p><p>After initial evaluation, many older syncope patients do not receive a diagnosis. Both head-up tilt tests (HUTT) and implanted cardiac monitors (ICM) are recommended, but there is no consensus about which should be done first. The study objective was to assess whether first conducting a HUTT vs ICM provided a higher, earlier diagnostic yield. This single-center, retrospective analysis study included patients with undiagnosed syncope and age ≥ 5o years after clinical and ECG evaluation. Exclusion criteria included ECG conduction abnormalities and structural heart disease with left ventricular ejection fraction < 50%. The primary outcome was an etiologic diagnosis of syncope within 1 year; secondary outcomes included time to diagnosis and the proportion with a syncope diagnosis at the end of follow-up. There were 233 patients (135 males), mean age 69 ± 10 years, with a median 3 historical syncopes. Baseline characteristics were similar except the ICM group had more mild cardiomyopathies, injuries, and beta-blockers and diuretic therapies. After one year, there were more diagnostic outcomes in the HUTT (65/104, 63%) than in the ICM (37/129, 29%) group (p < 0.00001). There were more diagnostic outcomes in the HUTT group by study completion (69/104 vs 58/129, p = 0.0015). The median times to a syncope diagnosis were 1 day in the HUTT group and 97 days in the ICM group (hazard ratio 3.88, CI 2.66, 5.67; p < 0.001). In older patients with syncope of unknown etiology, first conducting a HUTT provided an earlier and higher diagnostic yield than first implanting an ICM.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"2231-2239"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and predictors of complications of tube thoracostomy performed in the emergency department for non-traumatic pleural pathologies.","authors":"Andrea Rossetto, Martino V Aiello, Ludovica Tamburrino Orlando, Giada Ermini, Annamaria Cazzolla, Peiman Nazerian","doi":"10.1007/s11739-025-04148-2","DOIUrl":"10.1007/s11739-025-04148-2","url":null,"abstract":"<p><p>Tube thoracostomy (TT) is a common emergency procedure for the management of non-traumatic pleural conditions in the emergency department (ED). While effective, it carries a significant risk of complications. We aimed to assess the incidence and predictors of complications associated with TT performed in the ED for non-traumatic pleural pathologies. Retrospective cohort study involving adult patients undergoing TT in the ED of a University Hospital between 2020 and 2023 in Italy. Multivariable logistic regression was used to identify independent risk factors for complications. We enrolled 293 adult patients who underwent TT in the ED. Of these, 40% (116/293) were female, and the median age was 70 years (50-78). A pleural effusion was diagnosed in 67% (197/293) of patients, 11% (20/197) of whom had a loculated effusion, whereas a pneumothorax in 43% (126/293). TT-related complications occurred in 24% of cases, with malposition/dislodgment (13%), pneumothorax (9%) and obstruction (5%) most frequent. No deaths were directly attributed to TT. Multivariable analysis identified higher platelet counts (OR 1.39, 95%CI 1.02-1.89, p = 0.035) and localized pleural disease (OR 1.44, 95%CI 1.09-1.90, p = 0.011) as independent risk factors. No significant association was found with operator specialty, seniority, drain type, or time of procedure. TT performed in the ED for non-traumatic pleural diseases is associated with a complication rate comparable to other settings. Complicated pleural pathology and elevated platelet count were the main predictors of adverse events.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"2251-2258"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145372619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical governance of artificial intelligence in internal medicine: a literature-informed five-pillar framework for complex care.","authors":"Daniela Tirotta, Fabio Di Bello, Andrea Montagnani","doi":"10.1007/s11739-026-04408-9","DOIUrl":"10.1007/s11739-026-04408-9","url":null,"abstract":"<p><p>Most artificial intelligence (AI) governance frameworks in healthcare address model development, reporting standards, or regulation in broad terms, but do not adequately translate these principles into the operational realities of internal medicine. Although multimorbidity, frailty, polypharmacy, diagnostic uncertainty, incomplete data, and transitions of care are not exclusive to internal medicine, this specialty is characterized by its frequent and simultaneous convergence within the same clinical decision-making process. We developed a literature-informed conceptual framework through a targeted narrative review and interpretive synthesis of methodological, regulatory, implementation, and clinical literature on AI in healthcare. We examined five source domains: reporting and evaluation standards; risk-of-bias and model-appraisal tools; ethical and regulatory guidance; implementation, workflow, and electronic medical record literature; and internal medicine-specific literature on complexity, longitudinal care, and transitions of care. These domains were selected because they correspond to recurrent governance functions required for safe AI use: transparent evaluation, critical appraisal, accountability, workflow integration, data stewardship, and clinical-contextual interpretation. The synthesis highlighted a persistent gap between cross-cutting AI governance instruments and the discipline-oriented governance needs of internal medicine. This gap does not imply that existing frameworks are inadequate, but that their principles require translation into departmental governance structures capable of addressing complex, longitudinal, and multimorbid care. In particular, existing frameworks insufficiently address the interaction between algorithmic tools and the clinical complexity of multimorbid patients, the care-continuum nature of internist work, the role of electronic medical records as both data sources and clinical interfaces, and the growing role of AI in mediating access to scientific evidence. To address this gap, we propose a five-pillar framework comprising: (1) clinical oversight and human-in-the-loop decision-making; (2) data integration oriented to clinical complexity; (3) organizational embedding across the care continuum; (4) ethical, legal, and regulatory governance; and (5) governance of scientific knowledge and AI-mediated evidence access. We also provide an operational checklist to support local implementation readiness. AI should not be introduced into internal medicine as an isolated technological layer, but should be governed as a complex clinical intervention. A discipline-oriented five-pillar model may help departments, hospitals, and scientific societies assess not only whether an AI tool performs well, but whether the surrounding clinical, organizational, data, regulatory, and epistemic conditions are mature enough to support safe use.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1933-1944"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148054168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robustness of placebo-controlled trials of extended-duration direct oral anticoagulant therapy for secondary venous thromboembolism prevention.","authors":"Marco Zuin, Walter Ageno, Alessandro Squizzato, Pier Luigi Temporelli, Claudio Bilato, Gregory Piazza","doi":"10.1007/s11739-026-04410-1","DOIUrl":"10.1007/s11739-026-04410-1","url":null,"abstract":"<p><p>Direct oral anticoagulants (DOACs) have demonstrated efficacy in extended-duration secondary prevention in non-cancer patients with venous thromboembolism (VTE), but the robustness of these results has not been fully assessed. We performed a systematic review of phase 3 and 4 randomized placebo-controlled trials evaluating extended-duration DOACs therapy for secondary prevention of VTE. The primary outcome was symptomatic recurrent VTE in non-cancer patients. Secondary outcomes included major and clinically relevant non-major bleeding (CRNMB), number needed to treat (NNT), and number needed to harm (NNH). Fragility indices (FI) and quotients (FQ) were used to evaluate the robustness of trial findings. Four trials enrolling a total of 8,394 patients met the inclusion criteria. Extended-duration anticoagulation with DOACs consistently reduced recurrent VTE compared to placebo, with relative risk reductions of 80-93% and absolute risk reductions of 5-9%, yielding NNTs of 11-19. Extended DOACs therapy consistently showed net clinical benefit, with a pooled NNT of 14.4 versus an NNH of 116.2. Major bleeding was rare, while CRNMBs were slightly more common (although findings were statistically fragile across trials). Extended-duration DOACs therapy reduces recurrent VTE in non-cancer patients with a favourable safety profile compared to placebo in trial populations, supported by robust statistical evidence. These findings support DOACs as a preferred option for extended-duration secondary prevention of VTE.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"2165-2174"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148156353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opioid-induced constipation as an emergency: the other side of pain relief.","authors":"Gabrio Bassotti","doi":"10.1007/s11739-026-04485-w","DOIUrl":"10.1007/s11739-026-04485-w","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1959-1960"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148653315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic uncertainties in older inpatients with suspected heart failure with preserved ejection fraction: a pilot cohort study.","authors":"Roberto Presta, Enrico Brunetti, Francesco Palmas, Simone Carlone, Clara Musarò, Elena Cane, Marco Milan, Guido Sergio Giorgio Maggiani, Gianluca Isaia, Angela Sciacqua, Mario Bo","doi":"10.1007/s11739-026-04382-2","DOIUrl":"10.1007/s11739-026-04382-2","url":null,"abstract":"<p><p>Heart failure (HF) with preserved ejection fraction (HFpEF) is increasingly suspected in older adults. However, diagnosis remains challenging due to nonspecific symptoms, age-related structural cardiac changes, and confounding comorbidities. Reliability of algorithms developed in younger populations may be limited in this population. This prospective study enrolled inpatients aged > 75 years with at least one ESC-listed typical sign/symptom suggestive of HF and no prior HF diagnosis were evaluated for HFpEF using ESC 2021 criteria. Structural/functional transthoracic echocardiographic (TTE) abnormalities and age-adjusted NT-proBNP thresholds were recorded. Diagnostic accuracy of the H₂FPEF and HFA-PEFF scores was evaluated. We also tested a modified HFA-PEFF score incorporating age-adjusted thresholds for NT-proBNP and for septal/lateral e' velocity. Among 200 inpatients (median age 86.6 years, 58.0% women), 96.0% fulfilled ESC criteria, with TTE abnormalities almost universal (95.0%), mainly left atrial enlargement (70.0%) and increased wall thickness (66.5%). However, only 52.0% had elevated age-adjusted NT-proBNP. Notably, confounding comorbidities were very frequent (98.0%), particularly chronic kidney disease (60.0%) and infections (40.0%). Using rule-in cut-offs, H₂FPEF score identified few high-probability cases (7.0%) with very low sensitivity (0.07) and perfect specificity (1.00; AUROC 0.676). HFA-PEFF classified 67.5% of patients as high probability, with better accuracy (sensitivity 0.69, specificity 0.75; AUROC 0.856). The modified HFA-PEFF increased specificity (1.00) but reduced sensitivity (0.36), improving AUROC to 0.908 and lowering false positives. HFpEF diagnosis in older inpatients is complicated by overlapping comorbidities and age-related cardiac changes. Standard algorithms may misclassify patients and do not reflect true disease burden. Incorporating age-adjusted parameters in scores may improve specificity and support better clinical decision-making, but validation in larger studies is needed.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"2077-2086"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147874297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The IHCA paradox: high early mortality, yet comparable long-term survival in STEMI patients.","authors":"Aneta Aleksova, Alessandra Lucia Fluca, Milijana Janjusevic, Giulia Vanin, Gioachino Di Carlo, Giulia Barbati, Filippo Maria Rubbo, Leonardo Viotto, Kenneth Pesenti, Maria Marketou, Daniela Aschieri, Alberto Peratoner, Carlo Pegani, Andrea Perkan, Gianfranco Sinagra, Giuseppe Ristagno","doi":"10.1007/s11739-026-04372-4","DOIUrl":"10.1007/s11739-026-04372-4","url":null,"abstract":"<p><p>In-hospital cardiac arrest in STEMI (STEMI-IHCA) patients poses a formidable mortality risk, yet comprehensive survival data remain scarce. This study compared clinical characteristics and outcomes of STEMI-IHCA versus non-cardiac arrest (non-CA) patients. A cohort of 3311 STEMI patients, treated in the Cath lab and transferred to the intensive cardiac care unit, was retrospectively analyzed over a 21-year period (2003-2024). Of these, 208 (6.3%) had experienced STEMI-IHCA. The mean age was 66.2 ± 12.6 years; 77.8% were male. STEMI-IHCA patients more frequently had peripheral artery disease, multivessel disease, and renal impairment. In contrast, non-CA patients had higher rates of dyslipidemia and smoking. A striking 72.7% of STEMI-IHCA cases presented with a shockable rhythm, achieving rapid ROSC (< 1 min).Despite this, in-hospital mortality for STEMI-IHCA was drastically higher (25.5 vs. 2.8% for non-CA, p < 0.01), with most deaths occurring within three days (66 vs. 44.2%, p < 0.01). Predictors of in-hospital mortality were IHCA, older age, peripheral artery disease, reduced LVEF, and higher TIMI risk index. Among patients discharged alive, long-term mortality over a 96-month follow-up was similar between STEMI-IHCA and non-CA patients (36.8 vs. 33.3%, p = 0.37), confirmed by Kaplan-Meier analysis (p = 0.73) as well. Our findings confirm the high risk of in-hospital mortality risk associated with STEMI-IHCA. Nevertheless, among patients discharged alive, particularly with rapid ROSC, the long-term prognosis can align remarkably with that of STEMI patients who did not experience IHCA. This underscores the critical importance of prompt intervention as a powerful determinant of favorable long-term outcomes.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"2053-2063"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}