Abstract 15199: Effect of Adherence on an Invasive Approach to Cocaine Associated Non ST Elevation MI

Abstract

Background: Guidelines for the treatment of cocaine associated non-ST elevation myocardial infarction (CANSTEMI) suggest benefit with invasive approaches. There is reluctance to pursue invasive options due to concerns of medication non adherence. Hypothesis: To determine the effect of a history of medication adherence on invasive approaches to patients with CANSTEMI. Methods: The Nationwide Readmissions Database was queried from 2016 - 2017 for ICD-10 CM codes I21.4 in the primary diagnosis field and F14 in secondary fields for CANSTEMI. Coronary angiogram with or without percutaneous coronary intervention (PCI) was defined as invasive approaches. History of non adherence was identified by appropriate ICD-10 CM codes. The primary outcome was a composite of major adverse cardiac events (MACE) at one year. Secondary outcomes were all-cause mortality, myocardial infarction (MI) readmission, stroke readmission, and emergent revascularization at one year. Cox-Proportional Hazard regression was used to adjust for demographic and comorbid confounders. Results: We identified 7,372 patients with CANSTEMI, of which 5,236 (71.0%) were adherent and 2,138 (39%) were non adherent. In adherent patients, 1486 (28%) had CA and 1773 (34%) had PCI. In non adherent patients, 538 had CA (25%) and 546 (25%) had PCI. Neither age nor gender were associated with non adherence. Non adherent patients were more likely to have diabetes, COPD, CKD stage 3 or more, and anemia. The primary outcome of MACE was significantly lower at 1 year in adherent patients with invasive approaches, while emergent revascularization was not different. In non adherent patients, there was no difference in MACE with invasive approaches, while there was a significant increase in emergent revascularization (Figure 1). Conclusion: Patients with a history of adherence demonstrated significant benefits and reduced risks with an invasive approach, while similar benefit was not observed in non-adherent patients.