Abstract 13479: Impact of ST-Elevation Myocardial Infarction Among Hospitalized Patients With Coronary Artery Dissection: A United States Population-Based Cohort Study

Abstract

Introduction: ST-Elevation myocardial infarction (STEMI) is a rare but serious complication of coronary artery dissection (CADi). There is paucity of data on the in-hospital outcomes of hospitalized patients with CADi complicated by STEMI. Methods: We queried the National Inpatient Sample to identify patients with CADi who developed STEMI during the index hospitalization using appropriate ICD-10 codes between 2018-2020. We aim to investigate the impact of STEMI among CADi patients based on in-hospital mortality, risk for cardiogenic shock and arrythmias, utilization of coronary intervention, mechanical circulatory support, and mechanical ventilation. A multivariable logistic regression analysis was used to calculate adjusted odds ratios (ORs) for the outcomes of interest. Results: A total of 20,941 hospitalized patients with CADi were identified, of which 5.42% (1135/20,941) had concomitant STEMI during the index hospitalization. The overall in-hospital mortality rate among hospitalized patients with CADi was 6.45% (1,351/20,930). Among those with concomitant STEMI, the in-hospital mortality was significantly elevated to 18.5% (210/1,135, p= 0.00) compared to those who did not have STEMI. After adjusting for possible confounders, concomitant STEMI in CADi patients was found to be an independent significant predictor of increased risk for cardiogenic shock, development of ventricular tachycardia, ventricular fibrillation, utilization of percutaneous coronary interventions, coronary artery bypass graft, mechanical ventilation, and in-hospital mortality (Table 1). Conclusions: STEMI among CADi patients was independently associated with poorer cardiovascular and in-hospital mortality outcomes. Therefore, prompt recognition and treatment of underlying STEMI in CADi patients is necessary to prevent adverse outcomes.