Abstract 18970: Sex Differences and In-Hospital Outcomes of Acute Coronary Syndrome Among Patients With Mediastinal Radiation Exposure: Insights From the National Inpatient Sample (2009-2020)

Abstract

Background There is a paucity of data about the sex disparities and temporal trends in outcomes of Acute Coronary Syndrome (ACS) patients with prior mediastinal radiation. Methods: The National Inpatient Sample database years 2009 to 2020 was queried for ACS hospitalizations of patients with prior mediastinal radiation. The primary outcome was MACCE (major cardiovascular events) and secondary outcomes included other hospital cardiovascular outcomes including hospital resource utilization. Results: A total 23385 hospitalizations for ACS with prior mediastinal radiation exposure were identified. Females accounted for 15904 (68.01%) of the cases. Median age was 70 vs 72 and the majority of the cases were whites 82.79% vs 78.22% for females and males respectively. Cases were mostly non-ST elevation MI in both genders 75.98% vs 79.71% while ST-elevation MI represented 24.02% vs 20.29% of them. Female patients with ACS had a higher burden of hypertension, diabetes mellitus, hyperlipidemia and obesity, however, males had a higher burden of Peripheral vascular disease, chronic heart failure and smoking. After propensity matching, primary outcome related to MACCE was higher in males (aOR1.803, 95%CI (1.65-1.96)) along with cardiogenic shock (aOR: 1.77, 95%CI (1.55-2.02)) and Mechanical Circulatory Support (MCS) use (aOR: 1.48, 95%CI (1.29 -1.71)). Similar findings were noted after the subgroup analysis in STEMI and NSTEMI where males had the worst In-hospital outcomes compared to females. Overall, we observed an increasing trend in ACS hospitalizations among females from 2.85% in 2009 to 7.91% in 2020 however, mortality decreased over the years from 8.69% in 2009 to 3.51% in 2020. Conclusions: This nationwide observational analysis showed significant disparities and burden of cardiovascular comorbidities among male and female ACS patients with prior mediastinal radiation history, with higher hospitalization rates among females but higher mortality among males.