Abstract 16265: Acute Coronary Syndrome in Patients With Familial Hypercholesterolemia: Incidence, Predictors, and Outcomes

Abstract

Introduction: Individuals with Familial Hypercholesterolemia (FH) are at high risk for ASCVD events. However, little is known about the incidence, predictors, and outcomes of admissions for acute coronary syndromes (ACS) in this population. Objectives: To describe the in-hospital outcomes, readmission rates, and predictors of recurrent ACS in the FH population. Methods: Utilizing the National Readmission Databases from 10/2016 to 12/2017, we identified individuals with FH (ICD-10 E78.01) admitted with ACS. The primary outcome was in-hospital complications, which was compared using propensity-score matching (PSM 1:3). Multivariate logistic regression was performed to identify the predictors of 30-day readmissions. Results: There were a total of 1,697,513 ACS admissions during the study period (non-FH=1,969,979 and FH=534). Individuals admitted for ACS with FH were younger (median age 57 vs 69), had fewer comorbidities (hypertension, diabetes mellitus, and heart failure), were more likely to present with STEMI (32.8% vs 22.6%; p<0.01) and more likely to undergo multi-vessels revascularization (CABG 12.7% vs 5.9%, p<0.01; multivessel PCI 11.4% vs 7.6%, p<0.01) than patients without FH. After PSM, FH patients more commonly experienced in-hospital VT arrest [11.8% vs 8.0%; p<0.01] and required more frequent mechanical circulatory support [8.6% vs 3.3%; p<0.01]) compared to those without FH. Although FH patients who survived the initial index admission (97.9%) had lower 30-day readmission rates than non-FH patients (9.3% vs 15.1%; p<0.01), readmission was more frequently for cardiovascular disease (81.5% vs 46.5%; p<0.01). Predictors of 30-day readmission were young age, male sex, diabetes, history of CAD, and smoking (p<0.01). Conclusions: Individuals with FH admitted with ACS are younger, have fewer comorbidities, and more frequently present with STEMIs compared to those without FH. FH patients were more likely to suffer in-hospital cardiac complications. These results highlight the high-risk status of ACS and post-ACS care in FH patients.