Abstract

Introduction: Polycythemia vera (PV) is a well-known myeloproliferative disorder with an abundance of red blood cells as well as white blood cells and platelets. This condition is also known as hyperviscosity syndrome (HVS). Myocardial infarction (MI), a lethal disease, occurs due to impaired coronary blood supply to the heart. The hyperviscosity of coronary arterial blood flow in PV patients is associated with an increased risk for coronary syndrome. However, our study sought to determine if PV worsens the outcomes or aggravates ongoing MI in hospitalized patients. Methods: We queried the National Inpatient Sample (NIS) database from 2016 to 2019. The NIS is the largest inpatient hospitalization database in the United States. The NIS was searched for hospitalization of adult patients with MI as a principal diagnosis with and without PV as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality. The secondary results were Acute kidney injury (AKI), Cardiogenic shock (CS), Cardiac arrest (CA), Total hospital charge (THC), and length of stay (LOS). Multivariate logistic and linear regression analysis were used accordingly to adjust for confounders. Results: About 2,622,939 patients were admitted for MI; 0.091% (2,385) had underlying PV. Cohorts with PV vs No PV had a mean age of 69.2 years [CI 68.0 - 70.5] vs 66.9 years [CI 66.9 - 67.0]; male (66.2% vs 62.3%), female (33.8% vs 37.7%); white (85.3% vs 73.4%), black (5.6% vs 11.4%), and Hispanic (5.0% vs 8.8%). Compared to patients without PV, patients admitted with coexisting PV had similar inpatient mortality (5.7% vs 4.6%, AOR 1.17, 95% CI 0.79 - 1.73, P 0.437), AKI (20.3% vs 19.9%, P 0.546), CS (8.0% vs 6.3% P 0.222), CA (2.5% vs 2.9% P 0.690), THC (IRR 1.05, 95% CI 0.95 - 1.17, P 0.342), and LOS (IRR 1.06, 95% CI 0.95 - 1.18, P 0.277). Conclusion: Patients admitted primarily for MI with co-existing polycythemia vera had similar inpatient mortality. There was no difference in AKI, CS, CA, THC, and LOS in both groups. Phlebotomy in hospitalized Patients with MI and co-existing PV should be carried out with caution due to the risk of hypovolemia and possibly exacerbating the infarct. Additional studies are required to elaborate on the delicate management of this patient group.

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