INHOSPITAL OUTCOMES OF MYOCARDIAL INFARCTION IN SICKLE CELL DISEASE

Abstract

SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: Sickle cell disease (SCD) has been associated with considerable morbidity and mortality, including a higher risk for ST VS elevation myocardial infarction (STEMI). These patients often have few or no traditional risk factors for coronary artery disease, and risk stratification tools, such as the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) models place these patients at low risk. The mechanism of MI in SCD is not exactly known, as coronary angiography is often normal. However, the effect of SCD on outcome in patients with myocardial infarction remains unclear. We hereby report the in-hospital mortality in patients with SCD presenting with STEMI compared to the general population. METHODS: The National Inpatient Sample (NIS) dataset was queried from 2003 to 2014 to identify the primary diagnosis of STEMI (ICD-9 code: 410.x0, 410.x1,410.x2) among hospitalized patients. Among this patient population, we identified patients with SCD (ICD code: 282.41, 282.42, 282.6x) as a coexisting medical condition that is not directly related to the principal diagnosis. Categorical and continuous variables were tested using Chi-square test and Student t-test respectively. Multivariate regression was used for the analysis of primary outcomes of interest. RESULTS: Among 2,174,960 patients with STEMI only 120 patients were found to have SCD (0.005%). compared to the general population, patients with SCD were significantly younger (50 years vs. 63.4 years, p<0.001), were more likely to be female (56.7% vs. 32.8%, p=0.001) and, non-white (91.4% vs. 20.9%). Patients with SCD were found to have a higher prevalence of fluids and electrolyte disorders (45.38% vs 14.8%, p<0.0001), renal failure (19.11% vs 7.37%, p<0.0001), anemia (19.7% vs. 9.8%, p<0.0001) and, substance abuse (7.56% vs 2.07%, p<0.001). In terms of in-hospital outcomes, we found that the mean LOS (4.46 days vs 4.71, p =0.82) and cost ($68,866.00 vs $69,600.00, p= 0.96) were not significantly different between patients with SCD versus those without. However, the in-hospital mortality rate was higher among patients with SCD with STEMI (10% vs 7.07%, p= <0.001). Furthermore, the trend of SCD patients presenting with STEMI is largely unchanged while the trend for general population is generally down trending. CONCLUSIONS: Patients with SCD have a higher in-hospital mortality compared to the general population when presenting with STEMI. CLINICAL IMPLICATIONS: Given that patients with SCD are more likely to present with atypical clinical features making the diagnosis of STEMI difficult, and therefore delaying timely intervention; it is imperative that physicians are adept at recognizing this presentation in SCD patients. DISCLOSURES: No relevant relationships by Kathir Balakumaran, source=Web Response No relevant relationships by Aakash Desai, source=Web Response No relevant relationships by Arish Noor, source=Web Response No relevant relationships by Varun Tandon, source=Web Response