CLINICAL OUTCOMES OF INVASIVE VS NONINVASIVE MANAGEMENT OF NON-ST ELEVATION MYOCARDIAL INFARCTION IN PATIENTS ADMITTED FOR PNEUMONIA

Abstract

SESSION TITLE: Cardiovascular Disease Outcomes SESSION TYPE: Original Investigations PRESENTED ON: 10/09/2018 10:45 AM - 11:45 AM PURPOSE: Non-ST elevation myocardial infarction (NSTEMI) secondary to increased myocardial ischemic demand is a well-recognized complication of severe sepsis and septic shock. Despite this knowledge, the management of this group of patients is unclear. Our study aims to describe the prevalence of NSTEMI in patients who were hospitalized for pneumonia and the clinical outcomes of conservative therapy versus invasive intervention. METHODS: We queried the Nationwide Inpatient Sample database for patients hospitalized with a primary diagnosis of pneumonia who also were reported to have a secondary diagnosis of NSTEMI. Propensity score matching (PSM) using age, gender, co-morbidities and shock were performed to determine the statistical difference in outcomes based on coronary angiography (CA) status RESULTS: Of 904,617 patients who were hospitalized with pneumonia between January 2010 and December 2014, there were 11,154 (1.2%) patients who were diagnosed with NSTEMI. After PSM analysis, the mean age for both groups was 72.1 years and majority were male (N= 574; 56.1%). CA was performed in 1,127(10.1%) patients and 301 (26.7%) patients received percutaneous coronary intervention (PCI). There was significantly higher rate of CA at academic institution (N = 445 vs 378; p = 0.002). The non-CA group had more patients with history of PCI (N = 110 vs 155; p = 0.003) and coronary artery bypass grafts (N= 79 vs 169; p < 0.001). The CA group had higher rate of mechanical ventilation (N = 299 vs 245; p = 0.007), cardiac arrest (N=34 vs 18; p = 0.025) and cardiogenic shock (N = 17 vs 5; p = 0.010). The incidence of hemorrhage was also higher in the CA group (N = 19 vs 0; p < 0.001). The CA group had a significantly higher median length of stay (LOS) (8 days vs 6 days; p < 0.001), hospital cost, and in-hospital mortality (N = 48 vs 21; p = 0.001). CONCLUSIONS: NSTEMI is a relatively common diagnosis in patients who were admitted for pneumonia which leads to subsequent CA and PCI. In a propensity matched cohort of patients with a primary diagnosis of pneumonia, undergoing coronary angiogram for concurrent NSTEMI was associated with an increase in length of stay, in-hospital mortality, and hospital cost. CLINICAL IMPLICATIONS: The elevation of troponin in the patients who are overwhelm with sepsis requires careful interpretation and may require multidisciplinary approach since further intervention may not change the clinical outcomes. DISCLOSURES: No relevant relationships by Ahmed Abdel-Latif, source=Web Response no disclosure on file for NAOKI MISUMIDA; No relevant relationships by Gbolahan Ogunbayo, source=Web Response No relevant relationships by Suartcha Prueksaritanond, source=Web Response