Abstract 11247: Impact of Pre-Existing Heart Failure on Non-St Segment Elevation Myocardial Infarction Outcomes

Abstract

Introduction: There is limited data examining how pre-existing heart failure impacts patients with a non-ST segment elevation myocardial infarction (NSTEMI). In this study, we compare the in-hospital outcomes of NSTEMI patients with chronic heart failure with reduced ejection fraction (HFrEF) against NSTEMI patients with chronic heart failure with preserved ejection fraction (HFpEF). Methods: We queried the National Inpatient Sample database (2016-2019) to identify patients admitted with a principal diagnosis of NSTEMI and a secondary diagnosis of chronic heart failure. We conducted propensity score matching using a greedy nearest neighbor 1:1 model. Multivariable logistic regression was used to compare mortality. Results: 51,564 patients met our inclusion criteria. Patients with a NSTEMI and chronic HFrEF had 1.71 times higher odds of suffering in-hospital mortality compared to NSTEMI patients with chronic HFpEF (aOR 1.71, 95% CI: 1.55-1.90; p < 0.001). When separated by race, NSTEMI patients with HFrEF had a higher mortality rate amongst White patients (5.7% vs 4.4%, p < 0.001, Figure 1). These patients also had higher rates of coronary artery disease, hypertension and prior myocardial infarction (Table 1). There was no difference in percutaneous coronary intervention (21.7% vs 21.5%, p = 0.60, Table 1) or postoperative cardiac arrest, cerebral infarction and hemorrhage between our two cohorts. Conclusions: Patients with a NSTEMI and chronic HFrEF had higher odds of suffering in-hospital mortality compared to NSTEMI patients with chronic HFpEF. Further studies should explore the interventions providers may undertake to better support this vulnerable population.