Abstract 12184: Non-ST Segment Elevation Myocardial Infarction in Patients Admitted With Sepsis: A Comparison of Ischemia-Guided Strategy and Early Catheterization

Abstract

Introduction: Sepsis and Non-ST Segment Elevation Myocardial Infarction (NSTEMI) are common medical conditions that often coexist and can cause significant morbidity and mortality. The optimal management strategy for these patients remains unclear. The American Heart Association (AHA) recommends an ischemia-guided approach in patients with stable NSTEMI, but it is unknown if this strategy is beneficial in the setting of sepsis. The aim of this study was to evaluate the outcomes of an ischemia-guided strategy in patients with sepsis and NSTEMI who underwent left heart catheterization (LHC) and percutaneous intervention (PCI). Methods: This study utilized data from the National Inpatient Sample (NIS) from 2016-2020. Patients admitted with a principal diagnosis of sepsis and a secondary diagnosis of NSTEMI were included in the study. Patients with cardiogenic shock or STEMI were excluded from the study due to the necessity of urgent or emergent left heart catheterization. Patients were divided into two groups based on the timing of LHC & PCI, within 24 hours or 48-72 hours of admission. Logistic linear regression was used to adjust for multiple factors including patient demographics, hospital characteristics, and comorbidities. Results: A total of 298,855 patients were included in the analysis, with 48% of them being females and a mean age of 73 years. Patients who received an ischemia-guided strategy had lower mortality rates (OR: 0.45, 95% CI: 0.27-0.74, P=0.002) and a lower risk of heart failure exacerbation (OR: 0.74, 95% CI: 0.56-0.97, P=0.030) compared to those who did not receive this strategy. There was no significant difference in length of stay (Coefficient: 0.33, 95% CI: -0.34 - 1.01, P=0.330), cardiac arrest (OR: 0.08, 95% CI: 0.00-28.0, P=0.401), or gastrointestinal bleed (OR: 0.81, 95% CI: 0.49-1.33, P=0.412) between the two groups. Conclusion: This study suggests that an ischemia-guided strategy may be beneficial in patients with sepsis and NSTEMI compared to urgent percutaneous coronary intervention. The strategy was associated with lower mortality rates and a lower risk of heart failure exacerbation. Further studies are needed to confirm these findings and determine the optimal management strategy for this patient population.