S1008 STEMI-Induced Mortality in Liver Transplant Patients, Trends in Mortality, Associated Clinical Factors, Co-Morbidities and Management: A Report on NIS Data Analysis From 2012-2017

Abstract

INTRODUCTION: ST elevation myocardial infarction (STEMI) induced mortality is decreasing nationwide, however no report to date has examined STEMI mortality in liver transplant patients. We sought to examine the prevalence and trend of STEMI induced mortality, associated clinical factors, comorbidities, and treatment modalities used in liver transplant patients. METHODS: This is a retrospective cohort study of 318 liver transplant patients hospitalized with STEMI across the United States from 1/1/ 2012 to 12/31/2017. Patients were selected from NIS database using ICD codes 9 and 10. Descriptive statistics, student’s t-test and, chi square tests were used to analyze the data. Both males and females age 18 and above with urgent and emergent hospitalizations were included in the study. Primary outcome was in-hospital death. Potential confounders were age, sex, race, insurance type, admission day and, disposition. RESULTS: Mean age of the studied population was 62.3 ± 10.6 years. 27.8% (n = 88) were females and 84% were Caucasians. 64.3% of patients (n = 204) were managed with CABG and PCI vs 35.7% managed medically. During hospitalization, mortality rate was 11.3% (n = 36). Patients who died were relatively old (65.2 ± 7.1 vs. 61.9 ± 10.9, P-value: 0.02) and predominantly males (13.5% vs. 5.7%, P-value: 0.045). There was no statistically significant difference in mortality across different races (white: 12.8% vs. 13.6% non-white, P-value: 0.88). Prevalence of CHF (30% vs 10%, P < 0.001), coagulopathy (31% vs 8%) and, PVD (28% vs 10%, P: 0.01) was higher in deceased patients. There was an increase in trend noted in percentage of procedures (PCI and CABG) over the years (2002-2005: 42%, 2006-2009: 40%, 2010-2013:70%, 2014–2017: 79%, P value < 0.001). There was no difference in mean age between patients with and without procedures, however length of stay was longer 8 vs 3 days (P < 0.001) and hospitalization charges were higher $172144 vs $49977 (P < 0.001) in procedure group as comparted to medical management group. CONCLUSION: Mortality rate of STEMI in liver transplant patients is higher relative to general patient population (11.3% vs 10%). Patients who died were relatively old, predominantly males, and of Caucasian descent. There was an increase trend for procedures (CABG/ PCI) performed compared to medical management in transplant STEMI patients from 2002 to 2017.