Inflammatory Bowel Disease Does Not Impact Mortality, but Increases Length of Hospitalization in Patients with Acute Myocardial Infarction

Abstract

Purpose: A previous study has reported a survival advantage in patients with acute myocardial infarction (MI) who have rheumatoid arthritis. However, the outcomes of acute MI in patients with inflammatory bowel disease (IBD) (i.e. ulcerative colitis [UC] or Crohn's disease [CD]) are unknown. Methods: We performed a cross-sectional study, utilizing data from the Nationwide Inpatient Sample (NIS) from the years 1998-2010, to determine outcomes of MI in patients with UC and CD. ICD-9-CM codes were used to identify patients with CD (555.X), UC (556.X), and acute MI (410.X). First, we used logistic regression to determine the effect of UC and CD on MI mortality after adjusting for potential confounders. Then we compared the outcomes in MI patients who had UC and CD to matched MI patients without UC or CD. Matching was done for sex, Charlson Comorbidity Index (CCI), subtype of MI, primary payer, weekend admission, emergent or urgent admission, hospital region, urban location of hospital, teaching hospital status, calendar year (all exact match), age (+/- 2 years), and annual hospital MI volume (+/- 100). Results: Over 13 years, NIS contained data on 2,629,161 MI patients, of whom 3,607 had UC and 3,784 had CD. After applying sample weights, this is representative of 12,958,453 MI, 17,883 UC, and 18,809 CD patients. On multivariate logistic regression, UC (OR 1.12, 95% CI: 0.98-1.29) and CD (OR: 0.99, 95% CI: 0.86-1.15) did not affect in-hospital mortality in MI patients. The predictors of mortality from MI are shown in Figure 1. In the matched sample, there was no difference in MI in-hospital mortality in patients with UC vs. without UC (7.75% vs. 7.05%; P=0.25) or patients with CD vs. without CD (6.50% vs. 6.59%; P= 0.87). Table 1 shows the length of stay and total charges in the matched data set.Figure 1: Forest plot that shows the predictors of mortality.Table: Table. Shows the length of stay and total charges in the matched datasetConclusion: This study shows that having IBD does not impact in-hospital mortality from MI. However, MI patients with IBD have longer length of hospitalization compared to those without. In addition, MI patients with UC had higher total charges for hospitalization.