376 Prevalence and Mortality of Acute Myocardial Infarction in Cirrhotic Patients

Abstract

Background: The increased prevalence of non-alcoholic steatohepatitis (NASH) in cirrhotic patients will likely lead to higher rates of cardiac disease. Mortality in cirrhotic patients is often focused on complications of portal hypertension. In this study, we hoped to demonstrate the prevalence and clinical outcomes of cirrhotic patients with acute myocardial infarction (MI). Methods: Using the Clinical data repository we identified patients age ≥ 18 years from 1/1/2011 to 12/31/12 who were admitted with an International Classification of Disease-9 (ICD-9) code for cirrhosis and an ICD-9 code for acute MI. Inclusion required a diagnosis of cirrhosis based on biopsy or clinical, laboratory, and radiological findings. Acute MI was defined by the American Heart Association's 3rd Universal Definition of MI. Data regarding the type of MI, results of invasive or non-invasive testing, and in-hospital mortality were collected. Results: A total of 118 patients were identified, and of these 31 met the inclusion criteria. The overall prevalence of MI in hospitalized cirrhotic patients during the study period was 2.7%. Non-ST elevation MI (NSTEMI) Type 1 and Type 2 accounted for 84%. Only 5 patients sustained an ST-elevation MI (STEMI) and of these 4 underwent coronary angiography (2 were treated with stenting and 2 with balloon angioplasty alone). There were no in-hospital deaths in the STEMI group. Of the patients with NSTEMI, 75% with Type 1 NSTEMI underwent coronary angiography and 5 patients received a stent. One patient in this group required coronary artery bypass graft surgery. In-hospital mortality in the Type 2 NSTEMI group was 50%. In this group only 57% received aspirin and 29% received beta-blocker or statin therapy as part of their medical management. Average MELD score was higher in Type 2 compared to Type 1 NSTEMI (24 vs. 14, p<0.005). Overall inhospital mortality was 26%, with all deaths occurring in the NSTEMI group (8% in Type 1 vs. 50% in Type 2, p=0.04). Over half of the cirrhotic patients with MI were managed with medical therapy alone and the in-hospital mortality in that group was 35% compared to 14% in those who underwent coronary angiography. Conclusions: In cirrhotic patients, in-hospital mortality from MI was 26%. Further, in those patients with Type 2 NSTEMI, 50% of the patients did not survive the index hospitalization. Cirrhotic patients with MI were more likely to be managed with medical therapy alone and this was associated with a higher mortality rate compared to those undergoing invasive testing and coronary revascularization. Mortality of Non-ST Elevation Myocardial Infarction in Hospitalized Cirrhotic Patients