In-hospital Outcomes In Patients Research Articles

Mutliple Myeloma Increases the Mortality Rate in Patients Admitted for Upper GI Bleed: An Analysis of National Inpatient Database

Introduction Multiple myeloma is a malignant disease of terminally differentiated B cells presenting with bone lesions, renal abnormalities, electrolyte changes and infections. It can occasionally leave the bone medullary space and involve other systems like respiratory and gastrointestinal (GI) tract to form plasmacytomas. The extramedullary spread into the GI tract results in typical presentation of hematemesis and melena. There have been a few cases that have reported the same, but the true prevalence and mortality of these patients is not well known. The aim of the study was to evaluate role of multiple myeloma on the in-hospital outcomes in patients admitted for Upper GI bleed in the United States. Methodology We conducted retrospective analysis utilizing Nationwide Inpatient Database (NIS) from year 2016-2019. Patients with age 18 years or more admitted to the hospital due to non-variceal Upper GI bleed were included in our study and it was further divided based on presence (study group) or absence (control group) of underlying Multiple Myeloma. ICD-10 CM codes were used to identify patient population. Chi-square test was used to compare categorical variables and Wilcoxon rank sum test for continuous variables. Impact of multiple myeloma on the in-hospital outcomes and healthcare utilization was evaluated using multivariate logistic regression analysis. Results The sample size included 1,007,765 patients admitted for upper GI bleed, of which 0.31% had underlying multiple myeloma. Patients with underlying multiple myeloma were relatively older with mean age of 72 years compared to 65 years in group with no multiple myeloma (p<0.001). Females constituted 40.36% of the multiple myeloma group compared to 44.63% of patients without it. There was a higher mortality rate (5.03%) in those with multiple myeloma compared to those without it (1.9%) (adjusted OR=2.53, p<0.001). They also had a higher rate of blood transfusion (45.22% vs 33.91%) compared to those with no underlying multiple myeloma (adjusted OR=1.42, p<0.001). The adjusted mean total hospitalization charge was $14,531 higher and adjusted mean length of stay was 1.1 day more in those with underlying multiple myeloma compared to those without it, with p<0.001. Conclusion Our study showed that Multiple Myeloma increases the mortality rate by more than two and half fold in patients presenting with upper GI bleed. It also poses a significant burden on the healthcare and therefore, physicians should be more vigilant when encountered with such challenges. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Impact of Initial Operative Urgency on Short-Term Outcomes in Patients Treated with ECMO Due to Postcardiotomy Cardiogenic Shock.

The outcomes of patients with PCS and following ECMO therapy are associated with several preoperative risk factors. Our aim was to compare clinical presentation, ECMO-related data and in-hospital outcomes of patients treated with ECMO due to PCS after cardiac surgery, in regard to elective or emergent cardiac surgery procedures. Between April 2006 and October 2016, 164 consecutive patients that received VA-ECMO therapy due to PCS were identified and included in this retrospective cohort study. The patients were divided into groups based on the urgency of the initial procedures performed: elective group (ELG; n = 95) and an emergency group (EMG; n = 69). To compare the unequal patient groups, a propensity score-based matching (PSM) was applied (ELG, n = 56 vs. EMG, n = 56). The EMG primarily received ECMO intraoperatively (p ≤ 0.001). In contrast, the ELG were needed ECMO support more frequently postoperatively (p &lt; 0.001). In-hospital mortality accounted for 71% (n = 40) in the ELG and 76% (n = 43) in the EMG (p = 0.518). Outcome data showed no major differences in the (abdominal ischemia (p = 0.371); septic shock (p = 0.393): rhythm disturbances (p = 0.575); emergency re-thoracotomy (p = 0.418)) between the groups. The urgency of the initial procedures performed is secondary in patients suffering PCS and following ECMO. In this regard, PCS itself seems to trigger outcomes in cardiac surgery ECMO patients substantially.

The Effect of Admission During the Weekend On In-Hospital Outcomes for Patients With Peripartum Cardiomyopathy.

Background Previous studies have shown that patients with heart failure (HF) and cardiogenic shock (CS) have worse outcomes when admitted over the weekend. Since peripartum cardiomyopathy (PPCM) is a cause of CS and persisting HF, it is reasonable to extrapolate that admission over the weekend would also have deleterious effects on PPCM outcomes. However, the impact of weekend admission has not been specifically evaluated in patients with PPCM. Methods We analyzed the National Inpatient Sample (NIS) from 2016 to 2019. The International Classification of Diseases, tenth revision (ICD-10) codes were used to identify all admissions with a primary diagnosis of PPCM. The sample was divided into weekday and weekend groups. We performed a multivariate regression analysis to estimate the effect of weekend admission on specified outcomes. Results A total of 6,120 admissions met the selection criteria, and 25.3% (n=1,550) were admitted over the weekend. The mean age was 31.3 ± 6.4 years. There were no significant differences in baseline characteristics between study groups. After multivariate analysis, weekend admission for PPCM was not associated with in-hospital mortality, ventricular arrhythmias, sudden cardiac arrest, thromboembolic events, cardiovascular implantable electronic device placement, and mechanical circulatory support insertion. Conclusion In conclusion, although HF and CS have been associated with worse outcomes when admitted over the weekend, we did not find weekend admission for PPCM to be independently associated with worse clinical outcomes after multivariate analysis. These findings could reflect improvement in the coordination of care over the weekend, improvement in physician handoff, and increased utilization of shock teams.

Abstract 13066: Mortality Differences Between Urban and Rural Hospital Admissions for Left Atrial Appendage Occlusion

Introduction: There is a variation in cardiovascular outcomes between rural and urban hospitals such as higher mortality for AF. Whether such a relationship exists for safety and outcomes of left atrial appendage occlusion (LAAO) device implantation is unknown. Hypothesis: We hypothesized that LAAO procedure in rural hospitals is associated with worse in-hospital outcomes. Methods: A cross-sectional examination of patients who were hospitalized for LAAO procedure was performed in the National Inpatient Sample between 2016 and 2019 to compare in-hospital outcomes in patients admitted to urban vs rural hospitals. ICD 10 PCS code 02L73DK was used to identify hospitalizations with LAAO procedure. The cohort was further stratified into rural and urban hospitals. Chi-square test and multivariate logistic regression were used to analyze the association and statistical analyses were performed using weighted values. Results: A total of 61,390 hospitalizations for LAAO procedures were identified during the study period. From these, 1185 (1.93%) hospitalizations occurred in rural hospitals. Baseline characteristics and inpatient outcomes are shown in Table 1. LAAO in rural hospitalizations was associated with significantly higher in-hospital mortality [OR 2.94 (1.17-7.14), p&lt;0.001*]. This associated persisted even after adjusting for significant baseline characteristics [aOR 3.55 (1.42-8.84), p=0.006*). Conclusions: In-hospital mortality was significantly higher in patients undergoing LAAO in rural hospital. Further studies are needed to validate these findings in a prospective manner.

Abstract 14369: “July Effect”: Impact of Academic Year Transition on In-Hospital Outcomes of Patients With Cardiac Arrest

Introduction: The transition of training to a new Academic year and the beginning of training for new interns and fellows have been suggested to affect the quality of patient care and health care outcomes in critically ill patients, a phenomenon known as the “July Effect” in the United States. Prior studies have shown mixed reports regarding the “July Effect” existence. This study provides an insight into the “July Effect” in patients who suffered Cardiac arrest using a National Database. Methods: We performed a retrospective analysis using the National inpatient sample (2016- 2019). The NIS was searched for hospitalized adult patients with cardiac arrest as a principal diagnosis. We subsequently divided our sample into two cohorts based on the quarter of training (1st quarter, July to September, and the Last quarter of Training April to June). The primary outcome was inpatient mortality, and the secondary outcomes were the length of stay (LOS), total hospitalization charges (THC), and transfer frequency to other acute care facilities. Results: There were 27,940 Patients who suffered a cardiac arrest in the first and last quarter of our study period. Approximately 49.2% (13,755) vs. 50.8% (14,185) patients were identified in the 1st and Last quarters, respectively. There was a similar distribution of Age (63.5 ± 0.2) and Sex (Females) (43%) in both cohorts. There was similar inpatient mortality for patients who presented in both quarters (AOR 1.05, 95% CI 0.855-1.14, p=0.935). There was also no significant difference in LOS (adjusted coefficient -0.19, 95% CI -0.50-0.46, p=0.937), THC (adjusted coefficient 115.9, 95% CI -6483.46 - 6715, p=0.973) and frequency of transfer to other acute care facilities (AOR 0.95, 95% CI 0.82-1.11, p=0.57). Conclusions: This study suggests that the “July Effect” is not apparent in patients who suffered cardiac arrest as there were no significant differences in the rate of in-hospital mortality, length of stay, total hospitalization charges, and frequency of transfer to other acute care facilities.

Abstract 14592: Impact of Sodium Abnormalities: Hypernatremia vs Hyponatremia on Inpatient Hospital Congestive Heart Failure Outcomes: A National Inpatient Sample Data Analysis

Introduction Sodium abnormalities are commonly associated with congestive heart failure (CHF). The main objective of this study is to analyze the impact of hyponatremia vs. hypernatremia on in-hospital outcomes in patients admitted with CHF Methods The National inpatient sample (NIS) data from 2017 to 2018 were queried using International Classification of Diseases 10 (ICD-10-CM) codes E871 and E870. Demographics and hospital characteristics were compared along with In-hospital mortality, length of stay (LOS), and total charge. The outcomes were measured using linear and logistic regression models to adjust the odds ratio for confounders. Results: A total of 350,144 patients with heart failure as a primary diagnosis (42% systolic and 32% diastolic HF) were included in the study. Among them, 37,129 (10.7%) had hyponatremia while 5839 (1.8%) had hypernatremia. In-hospital mortality rates were significantly higher with an adjusted odds ratio (OR) of 2.78 (p&lt;0.001) among hypernatremia patients. Mean length of stay (LOS) was also high among hypernatremia patients (12.3 vs 8 days), with an adjusted odds ratio of 4.89 (p-value &lt;0.001). Similarly, mean total charges were higher in the hypernatremia group (175,632$ vs 91,022 $). Notably, hypernatremia was associated with more hemorrhage complications (OR-6.35, p &lt;0.001). Conclusions: Even though hypernatremia is less frequent than hyponatremia among CHF patients, it is associated with significantly higher mortality, LOS, and total charges than hyponatremia.

Abstract 14682: Gender Disparities in Hypertrophic Cardiomyopathy After Septal Myectomy - Insights From the National Inpatient Sample 2011-2019

Introduction: Data suggests that women with hypertrophic cardiomyopathy (HCM) have worse clinical outcomes than men. However, data from large multi-center studies on gender differences in patients who undergo septal myectomy (SM) is scarce. Methods: The National Inpatient Database was queried from 2011- 2019 for relevant ICD-9 and -10 diagnostic and procedural codes. We compared baseline characteristics and in-hospital outcomes of patients with HCM who underwent SM stratified according to male vs. female gender. A p-value &lt;0.001 was considered statistically significant. Results: We identified 10,805 patients with HCM who underwent SM, of which 55.4% were female. Women were significantly older (60.9 vs. 56.3 years), had more obesity (31% vs. 26.8%), heart failure (44.6% vs. 40%), chronic obstructive pulmonary disease (12.2% vs. 9.2%) and pulmonary hypertension (16.2% vs. 11.5%) (p&lt;0.001 for all) compared to men. Men had more hypertension (75.4% vs. 69.7%), tobacco use (41.5% vs. 34%), alcohol use (3.5% vs. 1.4%), hyperlipidemia (59.3% vs. 55.6%), obstructive sleep apnea (25.9% vs. 15%), coronary artery disease 41% vs. 32%), chronic kidney disease (12.6% vs. 8.7%), atrial fibrillation (46% vs. 40.9%), and atrial flutter (8.5% vs. 4.7%) (p&lt;0.001 for all) compared to women. In-hospital outcomes demonstrate women had higher all-cause mortality (3.3% vs. 1.6%, OR: 2.4 [1.5-4]) and more frequently required intra-aortic balloon pump placement (OR: 6.9 [2.7-19]) compared to men. Men had more intraoperative cardiac complications (OR: 1.4 [1.1-1.6]), pneumothorax (OR: 1.7 [1.25-2.5]), and pericardial complications (OR: 10 [3-33]) (p&lt;0.001 for all) compared to women. Conclusions: In patients with HCM who underwent SM, women had higher all-cause mortality despite having less comorbidities than men. These highlights potential gender differences in outcomes in patients referred for SM. Whether biases exist in referral patterns needs to be further elucidated.

Abstract 15879: Impact of Pulmonary Hypertension on In-Hospital Outcomes for Patients Undergoing Typical Atrial Flutter Ablation

Introduction: Pulmonary hypertension (PHT) is a progressive disease with a clinical course characterized by frequent decompensations in advanced stages. Atrial arrhythmias, including typical atrial flutter, are common in patients with PHT. We sought to investigate the effect of presence of pulmonary hypertension to the outcomes after typical atrial flutter ablation. Methods: We utilized the National Inpatient database from 2016 to 2019 to perform this study. By utilizing the ICD-10-CM codes all hospitalizations for typical atrial flutter ablation were identified. Patients with atypical flutter and ablation were excluded. Among these subjects, those with associated diagnosis of pulmonary hypertension (WHO Group 1 to 5) were identified and they formed the study group. Primary outcome was to in-hospital mortality and complications. Secondary outcomes included analysis of patient clinical characteristics, length of hospital stay (LOS) and total hospital charges (TOTCH). Multivariate regression analysis was used to predict outcomes. Results: A total of 7,784 patients with PHT were hospitalized for typical atrial flutter ablation during the study period. Patients with PHT were slightly older (66 vs 67 years, p&lt;0.001). The proportion of males was lower in the PHT group (57vs 67 %, p&lt;0.001). For Typical AFL patients undergoing ablation, the presence of PHT was associated with higher odds of mortality (a0R= 1.8, p=0.003), acute kidney injury (a0R= 1.6, p&lt;0.001), heart failure exacerbation (a0R= 1.3, p&lt;0.001) and cardiogenic shock (a0R= 2.2, p&lt;0.001) on multivariate regression analysis. They also had higher LOS (+2.3 days, p&lt;0.001) and TOTCH (+$30,501, p&lt;0.001). Conclusion: Our data shows that pulmonary hypertension is independently associated with worse in-hospital outcomes in patients undergoing typical atrial flutter ablation, including higher mortality. Further prospective studies are required to confirm our findings.

Abstract 14873: Analysis of Heart Failure Re-Admissions and In-Hospital Outcomes in Patients With Takotsubo Syndrome

Background: Takotsubo Syndrome (TTS) is characterized by transient reduction in left ventricular function with in the absence of obstructive coronary artery disease. Clinical presentation often mimics acute myocardial infarction (AMI). Patients with TTS have comparable long-term mortality with AMI patients. However, data on the burden of heart failure (HF) readmissions in patients with TTS are scarce. Methods: This retrospective analysis utilized the US Nationwide Readmission Database for the years 2012-2019 to identify hospitalizations for TTS or AMI. The primary outcome of interest was 6-month readmission due to HF. Secondary outcomes included in-hospital mortality. Results: There were 30,926 hospitalizations with TTS and 2,535,025 hospitalizations with AMI. The proportion of women was 90% among TTS patients and 37.7% among AMI patients (p&lt;0.001). Overall comorbidities were similar between the two groups, but in-hospital mortality during index admission was higher in the AMI arm (6.5% vs 1.5% in TTS, p &lt;0.01) accompanied with increased in-hospital complications. All-cause readmission rates were lower among TTS than among AMI patients (21.9% vs. 29.4%; p &lt;0.01). HF readmissions were also lower among TTS than AMI patients (3.7% vs. 6.7%; p &lt;0.01). After propensity matching, all-cause readmission rate remained lower among TTS than among AMI patients (21.9% vs. 27.9%; p &lt;0.01). HF hospital readmissions rates were also lower among TTS patients (3.7% vs 5.7%; p &lt;0.01). Independent predictors of HF readmission in TTS population included comorbidities such as diabetes mellitus, atrial fibrillation, chronic kidney disease, peripheral vascular disease, and chronic pulmonary disease. Conclusion A substantial proportion of patients (&gt;20%) with TTS suffer a hospital readmission within 6 months, although less than 5% are readmitted with HF. Compared with AMI, all-cause and HF readmission rates are lower in TTS patients.

Abstract 14365: In-Hospital Outcomes of Septal Myectomy versus Alcohol Septal Ablation for Hypertrophic Cardiomyopathy - An Update and Insights From the National Inpatient Sample

Introduction: Septal Myectomy (SM) and Alcohol Septal Ablation (ASA) improve symptoms in patients with Hypertrophic Cardiomyopathy (HCM), however, outcomes data in this population is predominantly from specialized centers. Methods: The National Inpatient Database was queried from 2011- 2019 for relevant ICD-9 and -10 diagnostic and procedural codes. Baseline characteristics and in-hospital outcomes of patients with HCM who underwent SM vs. ASA were compared. A p-value &lt;0.001 was considered statistically significant. Results: We identified 17,245 patients who underwent septal reduction therapies, of whom 62.5% underwent SM and 37.5% underwent ASA. Patients who underwent SM had higher all-cause mortality (OR:2.2 [1.7-2.9]), post procedure ischemic stroke (OR: 2.4 [1.8-3.2]), acute kidney injury (OR: 1.9 [1.7-2.2]), vascular complications (OR: 4 [2.8-5.7]), ventricular septal defect (OR: 4.6 [3.5-6.1]), aortic dissection/aneurysm (OR: 1.6 [1.3-2.1]), cardiogenic shock (OR: 2 [1.5-2.6]), sepsis (OR:5.2 [3.3-8.1]), and left bundle branch block (OR: 3.2 [2.8-3.7]) (p&lt;0.001 for all), compared to ASA. Patients who underwent ASA had higher post procedure complete heart block (OR: 1.2 [1.1-1.4]), 2 nd -degree AV Block (OR: 2 [1.4-3]), right bundle branch block (OR: 6.4 [5.3-7.8]), ventricular tachycardia (OR:2 [1.8-2.3]), supraventricular tachycardia (OR: 1.4 [1.2-1.7]), and more commonly required pacemaker (OR: 1.4 [1.2-1.6]) or implantable cardioverter-defibrillator (OR: 1.3 [1.1-1.5]) (p&lt;0.001 for all) insertion compared to SM. Conclusions: This nationwide analysis evidenced patients undergoing SM had higher in-hospital mortality and periprocedural complications compared to ASA, however, those undergoing ASA had higher post-procedure conduction abnormalities and pacemaker or ICD implantation. The implications of these findings warrant further investigation in regards to patient selection strategies for these therapies.

Abstract 14869: In-Hospital Outcomes and Predictors of Patients With Infective Endocarditis Undergoing Transcatheter Aortic Valve Replacement

Background: Although there is no clear indication on transcatheter aortic valve replacement (TAVR) in patients with infective endocarditis (IE), in some instances, TAVR remains the only possible option in some clinical scenarios. Methods: The National Inpatient Sample Database was queried from 2011-2019 for relevant ICD-9 and -10 diagnostic and procedural codes. Baseline characteristics and in-hospital outcomes of patients with a diagnosis of IE undergoing TAVR were queried. The association of baseline comorbidities with in-hospital mortality was determined using a binary logistic regression model to obtain adjusted odds ratios (aOR). Results: A total of 750 patients were identified with IE who underwent TAVR (0.3% of patients undergoing TAVR). In this cohort, 60% were male and 85% were white. Mean age was 73 ± 14 years old. At baseline, patients with IE had a prevalence of 80% of heart failure, 74% of hypertension (HTN), 58% of coronary artery disease (CAD), 49% of hyperlipidemia (HLD), 41% of chronic kidney disease (CKD), 39% of atrial fibrillation (AF), 29% of tobacco use, 27% of pulmonary hypertension, 23% of diabetes, 17% of peripheral vascular disease and 15% of history of stroke, amongst the most common ones. In-hospital death was 7.3% with a median length of stay of 8 days [IQ 2-19]. This population had an 85% rate of sepsis, 34% of acute kidney injury with 9% need of renal replacement therapy. Major bleeding was present in 17% with need of blood product transfusion in 17% of the cases. Other complications found were cardiogenic shock (13%), complete heart block (11%), vascular complications (7%), pericardial effusion (7%) with 3% of pericardiocentesis, 4% intraoperative cardiac complications and 5% of cardiac arrest. Mortality was mainly associated with HLD (aOR 11.073 [4.363-28.101]), HTN (aOR 3.863 [2.209-6.755]), HF (aOR 2.491 [1.392-4.456]) and CAD (aOR 2.597 [1.469-4.592], p&lt;0.05 for all). Conclusion: We found a higher mortality post-TAVR in patient with IE than the general population undergoing TAVR (~4%). Controlling baseline comorbidities such as HLD, HTN and HF might be an important treatment part to decrease the risk of in-hospital mortality post-TAVR in patient with IE. Further prospective studies are needed to elucidate these findings.

Abstract 15623: Arrhythmia Burden and Associated Outcomes Among Patients With Myelodysplastic Syndromes

Background: Arrhythmias are an increasingly recognized comorbid condition among patients with cancers. However, there is little research on the relationship between conduction abnormalities and in-hospital outcomes in patients with myelodysplastic syndrome (MDS). This analysis explores the burden of cardiac arrhythmias and associated outcomes in hospitalized MDS patients. Methods: Nationwide Inpatient Sample from 2017 to 2019 was used. MDS-associated hospitalizations with concurrent arrhythmia were identified using appropriate ICD-10 CM codes and compared to MDS-associated hospitalizations without arrhythmia. Primary outcome was all-cause in-hospital mortality. Secondary outcomes were in-hospital length of stay and total costs. Results: About 21% (n=4065) of MDS patients were diagnosed with an arrhythmia. Atrial tachycardias were most common (87%). Frequency of bradyarrhythmias, ventricular tachycardias, and unspecified arrhythmias were 10.7%, 10.4%, and 0.8%, respectively. The MDS-arrhythmia cohort were significantly older (78 vs 71 years), had higher number of comorbidities (&gt;3 Charlson Comorbidity Index score: 45.5% vs 30%), and were more likely men (57.8% vs 52.7%) (P &lt; 0.001). The MDS-arrhythmia cohort demonstrated higher all-cause mortality (10.6% vs. 5%) and had increased odds of in-hospital death after adjusting for sociodemographic and hospital level factors (AOR 2.2, 95% CI 1.59-2.91) (P &lt; .001). Hospital length of stay (8.5 vs. 8.0 days) and hospital charges ($104267 vs. $105654) were similar across both groups. Conclusions: Concurrent arrhythmias were associated with worse survival outcomes for patients with MDS. Understanding the mortality associated with arrhythmias in MDS patients may have clinical implications when planning treatment options in which cardiotoxicity is an adverse event. Awareness of the frequency and risk factors for arrhythmias in MDS patients may encourage the early introduction of cardiac monitoring for arrhythmias in hospitalized patients with MDS.

Abstract 10384: Impact of Preexisting Pulmonary Hypertension on Outcomes in Patients Hospitalized With Covid-19

Introduction: Pulmonary hypertension (PH) is commonly associated with cardiopulmonary co-morbidities that increase morbidity and mortality risk with COVID-19. Hypothesis: This study aims to evaluate the association between preexisting PH and in-hospital outcomes in patients admitted with COVID-19. Methods: Consecutive patients at a large New England academic health system hospitalized with COVID-19 between March 1 and December 31, 2020, who had prior echocardiograms with documented estimated right ventricular systolic pressure (RVSP) were included. PH was defined as RVSP ≥30 mm Hg. Multivariable logistic regression adjusting for demographic and clinical characteristics was employed to relate PH to a primary outcome of all-cause mortality, and secondary outcomes including non-invasive positive pressure ventilation (NIPPV), myocardial infarction (MI), intensive care unit admission (ICU), and recurrent heart failure (HF) individually. Results: Of the 656 patients admitted, 395 (60.2%) had documented PH on a prior echocardiogram. PH patients were older, more likely to be men, and have cardiopulmonary and renal disease. Patients with PH had larger atrial size and higher E to early diastolic mitral annular tissue velocity (E/e') but similar left ventricular and right ventricular function compared to patients without PH. All-cause mortality (21% vs 10.3%, p= 0.001), need for ICU level of care (19% vs 13%, p = 0.046), NIPPV (23% vs 16%, p = 0.03), and recurrent HF (18% vs 5%, p &lt; 0.001) were more common in patients with PH compared to those without. Unadjusted and adjusted odds ratios relating PH to study outcomes appear in the Table . Conclusions: Preexisting PH is independently associated with higher risk of all-cause mortality in patients who are hospitalized with COVID-19.

Abstract 11986: In-Hospital Outcomes in Patients With Peripheral Artery Disease Hospitalized for Acute Myocardial Infarction: From the NCDR Chest Pain Mi Registry

Introduction: Patients with peripheral artery disease (PAD) are at high risk for adverse cardiovascular events, including acute myocardial infarction (AMI). Though AMI care has improved, in-hospital outcomes for patients experiencing an AMI with comorbid PAD are not well described in recent practice. We hypothesized that patients with PAD would have higher rates of bleeding and mortality during AMI hospitalization. Methods: We assessed clinical characteristics and in-hospital major bleeding and mortality rates of patients admitted with AMI and comorbid PAD at 646 hospitals in the NCDR Chest Pain MI Registry from 1/2019 to 9/2021. Major bleeding and mortality were compared for patients with vs. without PAD using multivariable logistic regression. Results: Compared with patients admitted for AMI without PAD (n = 307,550), those with PAD (n = 24,585) were older, had more comorbidities including tobacco use, diabetes, prior AMI and heart failure, and more frequently presented with NSTEMI vs. STEMI. Patients with PAD had higher crude rates of in-hospital major bleeding (9.7% vs. 6.3%) and mortality (8.1% vs. 4.7%); in exploratory analyses, rates of other adverse in-hospital events were also higher ( Figure ). After multivariable adjustment, PAD was associated with an increased risk of major bleeding (adjusted OR [aOR] 1.23 [95% CI 1.17-1.30]). PAD was also associated with greater risk of in-hospital mortality (aOR 1.28 [95% CI 1.21-1.37]), particularly among patients over age 65 (aOR 1.32 [95% CI 1.23-1.42] for ≥65 years vs. 1.06 [95% CI 0.96-1.18] for patients &lt;65 years; interaction p = 0.02). Conclusions: Among patients hospitalized with AMI, those with PAD have greater comorbidity burden and increased risk of major bleeding. Patients with PAD, particularly those who are ≥65 years, also have increased risk of in-hospital death. These findings highlight a need for improved preventive efforts, tailored care pathways, and greater focus on AMI management in PAD patients.

Abstract 14299: In-Hospital Outcomes of Patients With Obstructive Sleep Apnea Undergoing Atrial Septal Defect Repair

Introduction: There is emerging new evidence of an association of atrial septal defects (ASD) with hypoxic conditions such as obstructive sleep apnea (OSA). In this study, we determined in-hospital outcomes of patients with OSA undergoing percutaneous ASD repair (ASDR). Methods: The National Inpatient Sample Database was queried from 2011-2019 for relevant ICD-9 and -10 procedural and diagnostic codes. Baseline characteristics and in-hospital outcomes were compared in patients with and without a history of OSA with a primary diagnosis of ASD who underwent ASDR (Surgical or percutaneous) on the index admission. Logistic-regression was performed to adjust for pre-specified co-variable for different outcomes. p-value was considered significant when &lt;0.001. Results: We identified a weighted sample of 132,221 patients (≥18 years old) with a primary diagnosis of ASD, out of whom 10.9% (14,457) had ASDR. Of patients who underwent ASDR, 11.2% (1,615) carried a diagnosis of OSA. Baseline characteristics are shown in Table 1. There was no statistically significant difference in all-cause mortality between patients who underwent ASDR, with and without OSA (2.7% vs 2.7%). After adjusting for potential confounders, there was no statistical difference between both groups’ in-hospital outcomes such as total cost, length of stay, acute renal failure, stroke rate, vascular or pericardial complications. Conclusions: Although patients with OSA who underwent ASD repair have higher co-morbidities, they were not at higher risk for inpatient complications post-procedure and there was no difference in mortality noted. Prospective studies are needed to further investigate the effect of ASDR in OSA patients.

Abstract 15252: Impact of Atrial Fibrillation on Patients With Carcinoid Syndrome: A National In-Patient Sample Analysis

Introduction: Carcinoid heart disease is one of the major causes of mortality in patients with carcinoid syndrome. Although right-sided valvular dysfunction is well studied in carcinoid heart, there are limited data on the impact of atrial fibrillation (AF) on in-hospital mortality in these patients. We sought to assess the in-hospital outcomes in patients with carcinoid syndrome and a concurrent diagnosis of AF. Methods: We analyzed the National Inpatient Sample database from January 2016- December 2018 to identify hospitalizations for Carcinoid syndrome using the ICD 10 CM code E34.0. Study cohort was further divided into patients with and without AF. Chi-square test and multivariate logistic regression were used to analyze the association. All statistical analyses were performed using weighted values. Results: During the study period, 9320 hospitalizations with carcinoid syndrome were identified. Among these, 1430 (15.3%) had atrial fibrillation. Baseline characteristics and outcomes are shown in table 1. Patients with AF were older (71.8±9.8 vs 63.4±13.6, p&lt;0.001) and had a higher Elixhauser comorbidity index (21.5±6.6 vs 17.6±6.5, p&lt;0.001). AF is noted to be associated with significantly higher in-hospital mortality (OR 2.0, 95% CI 1.6-2.5, p&lt;0.001), and respiratory failure requiring mechanical ventilation (OR 1.9, 95% CI 1.5-2.5, p&lt;0.001). After adjusting for age, sex, race, and significant baseline comorbidities, AF was independently associated with higher in-hospital mortality (aOR 1.64, 95% CI 1.3-2.1, p&lt;0.001*) and mechanical ventilation (aOR 1.88, 95% CI, 1.4-2.5, p&lt;0.001*) Conclusions: Atrial fibrillation is associated with significantly higher in-patient hospital mortality and mechanical ventilation in patients with carcinoid syndrome. Further longitudinal observational studies are needed to validate these findings.

Abstract 332: Does Concomitant Left Ventricular Unloading Improve Outcomes Of Cardiogenic Shock Managed By Venoarterial Extracorporeal Membrane Oxygenation? Analysis Of National Inpatient Sample Database 2019

Introduction: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is often used in patients with cardiogenic shock. However, this strategy can lead to left ventricular (LV) distention, thus compromising myocardial recovery. Therefore, concomitant LV unloading with an Impella device (Abiomed, Danvers, MA) has gained a wide interest to promote LV recovery. We aimed to investigate the in-hospital outcomes of patients with myocardial infarction and cardiogenic shock undergoing VA-ECMO with Impella (ECPELLA) versus VA-ECMO alone. Methods: We conducted a retrospective cohort study using the 2019 National Inpatient Sample Database. Variables were identified using their International Classification of Diseases, 10th revision (ICD-10) codes. Descriptive bivariate and multivariate analyses were performed. A p-value &lt;0.05 was considered statistically significant. Results: A total of 1915 records of acute myocardial infarction and cardiogenic shock treated with VA-ECMO were identified. Of these, 625 underwent ECPELLA, and 1,290 underwent VA-ECMO alone. Baseline characteristics and complication rates are listed in Table 1. Inpatient mortality rate was not statistically different between the ECPELLA and the VA-ECMO groups [50.4% (n=315) vs 46.1% (n=595), respectively, p=0.08]. In addition, a multivariable logistic regression model adjusting for potential confounders (baseline characteristics in Table 1, as well as primary expected payer, left heart catheterization, and initial presentation with cardiac arrest) did not show a mortality benefit for ECPELLA over VA-ECMO (OR 1.206, 95% CI 0.967-1.50, p=0.097). However, rates of acute renal failure requiring hemodialysis and intracranial hemorrhage were lower in the ECPELLA group. Conclusion: Our data suggests that there is no survival to hospital discharge benefit for ECPELLA vs VA-ECMO. Prospective studies are warranted to validate our findings. .

Abstract 15360: Characteristics and In-Hospital Outcomes of Patients Undergoing Pulmonary Vein Isolation With and Without Adjunctive Lesions: Insights From the Ncdr Afib Ablation Registry

Introduction: The optimal ablation strategy beyond pulmonary vein isolation (PVI) for atrial fibrillation (AFib) is undefined. No prior study has been adequately powered to evaluate real-world safety outcomes in those receiving adjunctive (adj) ablation lesions. We sought to evaluate characteristics and in-hospital complications among patients undergoing AFib ablation with PVI with and without adj lesions. Hypothesis: PVI + adj will be more common in those with persistent AF (persAF) and be associated with adverse events. Methods: Patients enrolled in the National Cardiovascular Data Registry AFib Ablation Registry undergoing first-time ablation between 2016 and 2020 were stratified into paroxysmal (PAF) and persAF, and separated into PVI only, PVI+cavotricuspid isthmus (CTI) ablation alone, PVI+adj (SVC isolation, coronary sinus, vein of Marshall, atypical atrial flutter lines, other). In-hospital outcomes were compared using multivariable logistic regression. Results: A total of 50,937 patients were included. Among PAF, as compared to PVI only, both PVI+CTI and PVI+adj were associated with prolonged hospitalization after adjustment, while there were no differences in complications. In the persAF cohort, as compared to PVI only, PVI+adj was associated with a higher risk of any complication and major complication, while no differences were observed in PVI+CTI (Table). In-hospital death was rare with no differences across groups. Conclusion: Adjunctive lesions are commonly performed in real-world practice in both PAF and persAF with varied strategies. Among PAF, additional lesions were associated with prolonged hospitalization, although not complications. Among persAF, PVI+adj, but not PVI+CTI, was associated with a higher risk of complications. While additional CTI ablation may be considered safe in persAF, further efforts to determine optimal ablation strategies beyond PVI and mitigate risk are warranted.

Abstract 11121: In-Hospital Outcomes of Aortic Dissection in Patients With Substance Use Disorder

Introduction: Substance Use Disorder (SUD) is a chronic relapsing disease emanating from the uncontrolled use of drugs despite devastating physical, neurologic and psychological consequences. Studies have proven an association of SUD with a variety of life-threatening cardiac conditions. Aortic dissection (AD) is an acute condition caused by a tear in the inner layer of the aorta and requires immediate intervention. Our study aimed to ascertain the in-hospital outcomes of patients with substance use disorders presenting with Aortic dissection using a national representative sample. Methods: This was a retrospective study done using the 2016-2019 National inpatient sample, ICD 10 codes were used to identify individuals who were admitted for aortic dissection who were further categorized into two groups based on a history of SUD or not. Multivariate analysis was used to control for confounders and assess in-hospital mortality and other hospital outcomes. Results: A total of 63,380 patients were admitted for Aortic dissection during the study period. 26% (16,775) of the population sample had active abuse of at least 1 substance. AD was identified in a younger age group with SUD vs those without SUD with a mean age of 57. vs 65 years respectively. 68% of patients with SUD were found to be males with the predominant race being white (56%). A higher proportion of SUD patients had co-morbid Hypertension (60%) and smoked Cigarette (92%). Comparing both groups, there was no statistical difference in in-hospital mortality (AOR 1.06, 95% CI 0.88-1.26, p=0.50). However, there was a higher risk of acute coronary syndrome (AOR 1.77, 95% CI 1.20-2.40, p= 0.01), Cardiogenic shock (AOR 1.26, 95% CI 1.01-1.57, p&lt; 0.001) and Embolic stroke (AOR 1.33, 95% CI 1.05-1.67, p=0.019) in the SUD group. We also observed no difference in the mean length of stay (adjusted coefficient 0.456, 95% CI 0.049- 0.96, p=0.077) or the mean of total hospital charges (adjusted coefficient 3882, 95% CI -10548.17- 18313.79, p= 0.60) in both groups. Conclusions: We observed that in hospitalized patients with AD, SUD is not associated with an increased risk of in-hospital mortality, however, there is a significantly increased risk of cardiogenic shock, coronary syndrome, and embolic stroke.

Abstract 11522: Impact of Chronic Glucagon-Like Peptide-1 Receptor Agonist and Sodium Glucose Cotransporter-2 Inhibitor Therapy on In-Hospital Outcomes of Patients Hospitalized With Acute Myocardial Infarction

Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium glucose cotransporter-2 inhibitors (SGLT-2i) demonstrated cardiovascular and renal protection in addition to their glucose-lowering effect. Whether their benefits occur also in patients with diabetes mellitus (DM) during hospitalization with acute myocardial infarction (AMI) has not been investigated yet. Methods: We evaluated in-hospital outcomes of patients hospitalized with AMI according to their chronic use (before hospitalization) of GLP-1 RA and SGLT-2i therapy. Using administrative healthcare databases, we analyzed patients hospitalized with a primary diagnosis of AMI from 2010 to 2019 in the Lombardy region, Italy. Patients were stratified according to their DM status, then divided into three cohorts: Group 1 (non-DM patients); Group 2 (DM patients taking GLP-1 RA or SGLT-2i); and Group 3 (DM patients not taking GLP-1 RA and/or SGLT-2i). Patients were matched in a 1:1:1 ratio using a propensity score including all available variables. The primary endpoint of the study was the composite of in-hospital mortality, acute heart failure, and acute kidney injury requiring renal replacement therapy. Results: We identified 146,800 patients hospitalized with AMI (26% of them with DM). After propensity score matching, 1,030 patients were included in each group. The primary endpoint rate in the overall population was 16% (n=502) and it significantly increased going from Group 1 to Group 3 (13%, 16%, and 20% respectively; p for trend &amp;lt0.0001). The risk of the composite endpoint significantly increased from Group 1 to Group 3 (P for trend &amp;lt0.0001). In comparison with Group 2, Group 3 had a significant higher risk of the composite endpoint (OR 1.40 [95% CI 1.11-1.77]). Conclusions: Our study shows that DM patients hospitalized with AMI and on chronic GLP-1 RA and/or SGLT-2i therapy have a better in-hospital clinical outcome than DM patients without them.