Primary Diagnosis Of ST-elevation Myocardial Infarction Research Articles

In-hospital outcomes of anterior versus non-anterior st elevation myocardial infarction complicated with complete atrioventricular block

Abstract Background Complete atrioventricular block (CAVB) is an infrequent complication of acute ST-elevation myocardial infarction (STEMI), and information on its outcomes is scarce. We aimed to address the characteristics and in-hospital outcomes of patients with anterior versus non-anterior STEMI complicated with CAVB in a contemporary, nationwide, all-comer registry, in the U.S. Methods Using the National Inpatient Sample (NIS) database, we identified patients who were hospitalized with STEMI, complicated with CAVB between 2016- 2019. Patients with any cardiac implantable electronic device (CIED) in-situ were excluded. Baseline characteristics, in-hospital procedures and outcomes including time to temporary or permanent pacemaker (PPM)/implantable cardioverter defibrillator (ICD) implantation, length of stay and mortality were collected. Results A total of 17470 patients, were hospitalized with a primary diagnosis of STEMI and concomitant diagnosis of CAVB, 2755(15.8%) with Anterior and 14715(84.2%) with non-anterior STEMI. Non-anterior STEMI patients included more women, had higher prevalence of hypertension, dyslipidemia, smoking history and chronic pulmonary disease, while anterior STEMI patients had higher prevalence of chronic kidney disease and ischemic cardiomyopathy. Anterior STEMI patient had significantly higher rate of in hospital death [955 (35%) vs 2220 (15%), p<0.001], CPR, VT/VF, cardiac arrest, acute heart failure, respiratory failure, mechanical ventilation >96 hours and acute kidney injury. In both groups 40% received temporary pacemaker, but mean time to implantation was longer in anterior STEMI patients [1.1±3.3 vs 0.3±1.2 days, p<0.001]. Rate of any permanent CIED implantation was also significantly higher in the anterior STEMI patients with longer time to PPM implantation, [3.3±3.5 vs 2.8±2.8 days, p<0.001]. Use of mechanical circulatory support devices was significantly higher in anterior STEMI patients. Conclusion In STEMI patients complicated with CAVB, in-hospital outcomes of anterior STEMI were worse comparing to non-anterior STEMI, with significantly higher rates of in-hospital death, in-hospital complications and CIED implantations.

Abstract 15112: Characteristics and Clinical Outcomes of Patients With Sarcoidosis Admitted for ST-Elevation Myocardial Infarction

Background: Multisystem involvement is often seen in sarcoidosis. This study aims to explore the characteristics and clinical outcomes following hospitalization for ST-elevation myocardial infarction (STEMI) in patients with sarcoidosis when compared to patients without sarcoidosis. Methods: Patients with and without sarcoidosis admitted for STEMI were identified and compared from the 2016-2020 National Inpatient Sample (NIS) database whilst adjusting for confounders via logistic regression models. Results: A total of 851290 patients hospitalized with a primary diagnosis of STEMI between 1 st January 2016 to 31 st December 2020 were identified. Around 1215 (0.1%) had a diagnosis of sarcoidosis consisting of 58.4% males. When compared to patients without sarcoidosis, patients with sarcoidosis had a longer mean length of stay (LOS: 4.76 vs. 4.01 days, p<0.01), a greater prevalence of diabetes (42.4% vs. 32.4%, p<0.01), cirrhosis (1.6% vs. 0.5%, p<0.01), depression (9.1% vs. 6.7%, p<0.01), peripheral vascular disease (7.8% vs. 5.1%, p<0.01), obesity (24.3% vs. 17.8%, p<0.01), chronic kidney disease (25.9% vs. 13.1%, p<0.01) and prior stroke (7.4% vs. 5.2%, p<0.01). However, patients without sarcoidosis had a higher incidence of percutaneous coronary intervention (PCI) (79.8% vs. 75.3%, p<0.01), smoking (52% vs. 35.4%, p<0.01), drug abuse (2.8% vs. 1.2%, p<0.01) and alcohol abuse (3.5% vs. 2.1%, p<0.01) (Table 1A). Moreover, patients with sarcoidosis were less likely to have cardiogenic shock during their hospitalization (12.3% vs. 13.7%, aOR 0.768, 95% CI 0.636-0.927, p<0.01). No statistically significant differences were seen for CABG or PCI use, events of Acute Kidney Injury, acute ischemic stroke and death (Table 1AB). Conclusion: Patients with sarcoidosis admitted for STEMI had a longer length of stay and fewer cardiogenic shock incidence when compared to patients without sarcoidosis. Complications and mortality was otherwise comparable.

Abstract 194: Impact Of Psoriasis On The Outcomes Of St-elevation Myocardial Infarction From The Nationwide Readmission Database

Background: Psoriasis is a chronic inflammatory disease which causes atherosclerosis. There is conflicting data regarding the association between psoriasis and the development of cerebrovascular diseases with increased mortality. There is also limited data about the outcomes of the psoriatic patients presenting with ST-elevation myocardial infarction (STEMI). Methods: We queried the Nationwide Readmissions Database (years: 2016-2019) using ICD-10 codes for patients with a primary diagnosis of STEMI who underwent primary percutaneous coronary intervention (PCI). Patients were classified into two groups according to the presence of psoriasis. Outcomes included in-hospital mortality, index admission compilations, 90-day readmission rate, and causes of readmissions. Results: A total of 52,796 patients with STEMI underwent PCI including 308 with psoriasis and 52,488 with no psoriasis. Mean age and gender were similar between both groups. Psoriasis patients had more prevalence of obesity, diabetes mellitus (DM) obstructive sleep apnea (OSA) and depression. In-hospital mortality rate was not significantly different between the two groups. The length of stay and the total charges were higher in the psoriasis group (Table 1). During the index admission, the most common complications were not different. However, hemorrhagic anemia was higher in the psoriatic group. There were 6,896 (13.1%) readmission in the non-psoriasis group compared to 28 (9.1%). Conclusion: Patients with psoriasis had higher prevalence of cardiovascular risk factors including obesity, OSA, and DM, without a significant increase in the in-hospital mortality and the 90-day readmission rate.

Treatment Effect of Percutaneous Coronary Intervention in Dialysis Patients With ST-Elevation Myocardial Infarction

Patients receiving maintenance dialysis have higher mortality after primary percutaneous coronary intervention (pPCI) than patients not receiving dialysis. Whether pPCI confers a benefit to patients receiving dialysis that is similar to that which occurs in lower-risk groups remains unknown. We compared the effect of pPCI on in-hospital outcomes among patients hospitalized for ST-elevation myocardial infarction (STEMI) and receiving maintenance dialysis with the effect among patients hospitalized for STEMI but not receiving dialysis. Retrospective cohort study. We used the National Inpatient Sample (2016-2018) and included all adult hospitalizations with a primary diagnosis of STEMI. Primary exposure was PCI. Confounders included dialysis status, demographics, insurance, household income, comorbidities, and the elective nature of the admission. In-hospital mortality, stroke, acute kidney injury, new dialysis requirement, vascular complications, gastrointestinal bleeding, blood transfusion, mechanical ventilation, palliative care, and discharge destination. The average treatment effect (ATE) of pPCI was estimated using propensity score matching independently within the group receiving dialysis and the group not receiving dialysis to explore whether the effect is modified by dialysis status. Additionally, the average marginal effect (AME) was calculated accounting for the clustering within hospitals. Among hospitalizations, 4,220 (1.07%) out of 413,500 were for patients receiving dialysis. The dialysis cohort was older (65.2 ± 12.2 vs 63.4 ± 13.1, P< 0.001), had a higher proportion of women (42.4% vs 30.6%, P< 0.001) and more comorbidities, and had a lower proportion of White patients (41.1% vs 71.7%, P< 0.001). Patients receiving dialysis were less likely to undergo angiography (73.1% vs 85.4%, P< 0.001) or pPCI (57.5% vs 79.8%, P< 0.001). Primary PCI was associated with lower mortality in patients receiving dialysis (15.7% vs 27.1%, P< 0.001) as well as in those who were not (5.0% vs 17.4%, P< 0.001). The ATE on mortality did not differ significantly (P interaction= 0.9) between patients receiving dialysis (-8.6% [95% CI,-15.6% to-1.6%], P= 0.02) and those who were not (-8.2% [95% CI,-8.8% to-7.5%], P< 0.001). The AME method showed similar results among patients receiving dialysis (-9.4% [95% CI,-14.8% to-4.0%], P< 0.001) and those who were not (-7.9% [95% CI,-8.5% to-7.4%], P< 0.001) (P interaction= 0.6). Both the ATE and AME were comparable for other in-hospital outcomes in both groups. Administrative data, lack of pharmacotherapy and long-term outcome data, and residual confounding. Compared with conservative management, pPCI for STEMI was associated with comparable reductions in short-term mortality among patients irrespective of their receipt of maintenance dialysis.

Abstract 17260: In Hospital Outcomes and Prevalence of Comorbidities in Patients With ST Elevation Myocardial Infarction With and Without Infective Endocarditis - Insight From National Inpatient Sample (2013-2014)

Introduction: In infective endocarditis (IE), embolization to the coronary arteries is an uncommon phenomenon but can contribute to transmural infarction presenting as ST elevation myocardial infarction (STEMI). Due to limited date, we intend to evaluate the clinical outcomes in hospitalized patients with STEMI with and without underlying IE. Hypothesis: Morbidity and morbidity exponentiates in STEMI with comorbid IE when compared to without IE. Methods: Patients with primary diagnosis of STEMI with and without IE were identified by querying the Healthcare Cost and Utilization (HCUP) database, specifically, National Inpatient Sample for year 2013 and 2014 based on ICD9 codes Results: During 2013 and 2014, a total of 117, 386 patients were admitted with the principle diagnosis of STEMI, out of whom 305 had comorbid IE. There was an increased in-hospital mortality (27.5% vs 10.8%, increased length of stay (14 vs 5 days), acute kidney injury (44.9% vs 18.7%), stroke (23.6% vs 3%), aortic valve replacement (9.5% vs 0.3%), mitral valve replacement (0.2%-5.2%), sepsis (50% vs 6%) and acute respiratory failure (36.7% vs 16.7%) in patients with STEMI with IE when compared to patients with STEMI and without comorbid IE. STEMI without IE had higher number of angiographies (58.7% vs 25.9%) and percutaneous coronary interventions (50.7% vs 14.4%) during their hospital course when compared to STEMI with IE. Conclusions: We conclude that hospitalized STEMI patients with concomitant diagnosis of IE are at higher risk of in-hospital mortality, increased LOS, AKI, stroke, valve replacements, and acute respiratory failure. Clinical trials that compare optimal interventions in these patients would be needed in future.

In-hospital outcomes and prevalence of comorbidities in patients with ST-elevation myocardial infarction with and without infective endocarditis: insight from the National Inpatient Sample (2013–2014)

In patients with infective endocarditis (IE), ST-elevation myocardial infarction (STEMI) is an uncommon phenomenon. Due to limited data, we intend to evaluate the clinical outcomes in hospitalized patients with STEMI...

MON-643 Diabetes’ Cost to Us Taxpayers: Thirty-Day Readmission and Resource Utilization Among Diabetics Patients Admitted with ST-Elevation Myocardial Infarction: A Propensity Score Match Analysis

PURPOSE: To determine the relationship between diabetes and thirty-days readmission, mortality, morbidity, and health care resource utilization in patients who were admitted with ST-Elevation Myocardial Infarction (STEMI) in the United States. METHOD: A retrospective study was conducted using the AHRQ-HCUP Nationwide Readmission Database for the year 2014. Adults (≥ 18 years) with a primary diagnosis of STEMI (1), along with a secondary diagnosis of diabetes were identified using ICD-9 codes as described in the literature (2). The primary outcome was the rate of all-cause readmission within 30 days of discharge. Secondary outcomes were reasons for readmission, readmission mortality rate, morbidity, and resource use (length of stay and total hospitalization costs and charges). Propensity score (PS) using the 1:1 nearest neighbor matching without replacement was utilized to adjust for confounders (3). Independent risk factors for readmission were identified using a Cox proportional hazards model (4). RESULTS: In total, 116,124 hospital admissions among adults with a primary diagnosis of STEMI were identified, of which 18.05% were diabetics. 1:1 PS matching was performed based on demographic (age, gender, hospital status, etc.) and clinical characteristics (Charlson comorbidity score. The 30-day rate of readmission among diabetics and non-diabetics with STEMI were 9.31% vs. 6.18% (p <0.001). The most common readmission for both groups was recurrent myocardial infarction. During the index admission for STEMI, the length of stay (LOS) among diabetics and non-diabetics patients were not statistically different (4.74 vs 4.58 days, p=0.12). However, the total hospital cost for the diabetic patients was statistically different ($27,027 vs $24,807, p <0.001). Most importantly, diabetics patients’ in-hospital mortality rate during their index admission was significant higher (10.20% vs 5.92%, p <0.001). Amongst those readmitted, the LOS, total hospital cost, or in-hospital mortality among diabetics were not statistically different when compared to their counterparts during their readmission. Diabetes (HR 1.60, CI 1.27-2.02, p <0.001) was an independent predictor associated with higher risks of readmission. Other independent predictors associated with increased 30-day readmission include acute exacerbation of CHF, acute exacerbation of COPD, acute kidney injury, secondary diagnosis of pneumonia, history of COPD, history of ischemic stroke, history of atrial fibrillation & atrial flutter, history of chronic kidney disease, history of iron deficiency, and use of mechanical ventilator. CONCLUSION: In this study, diabetics patients admitted with STEMI have a higher 30 days of readmission rate, total hospital cost, and in-hospital mortality (p <0.001) than their non-diabetic counterparts.

IMPACT OF CHRONIC KIDNEY DISEASE ON THE SIX-MONTH READMISSION RATE OF PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION: A NATIONWIDE ANALYSIS

Limited data exist regarding the impact of chronic kidney disease (CKD) on readmission rates and mortality in patients with ST-elevation myocardial infarction (STEMI). Using the 2016 Nationwide Readmission Database, we identified patients hospitalized with a primary diagnosis of STEMI and

Rationale and design of the Henan ST elevation myocardial infarction (STEMI) registry: a regional STEMI project in predominantly rural central China

BackgroundCardiovascular disease including ST elevation myocardial infarction (STEMI) is increasing and the leading cause of death in China. There has been limited data available to characterize STEMI management and outcomes in rural areas of China. The Henan STEMI Registry is a regional STEMI project with the objectives to timely obtain real-world knowledge about STEMI patients in secondary and tertiary hospitals and to provide a platform for care quality improvement efforts in predominantly rural central China.MethodsThe Henan STEMI Registry is a multicentre, prospective and observational study for STEMI patients. The registry includes 66 participating hospitals (50 secondary hospitals; 16 tertiary hospitals) that cover 15 prefectures and one city direct-controlled by the province in Henan province. Patients were consecutively enrolled with a primary diagnosis of STEMI within 30 days of symptom onset. Clinical treatments, outcomes and cost are collected by local investigators and captured electronically, with a standardized set of variables and standard definitions, and rigorous data quality control. Post-discharge patient follow-up to 1 year is planned. As of August 2018, the Henan STEMI Registry has enrolled 5479 patients of STEMI.DiscussionThe Henan STEMI Registry represents the largest Chinese regional platform for clinical research and care quality improvement for STEMI. The board inclusion of secondary hospitals in Henan province will allow for the exploration of STEMI in predominantly rural central China.Trial registration[NCT02641262] [29 December, 2015].

Relation of CHA2DS2VASC Score With Hemorrhagic Stroke and Mortality in Patients Undergoing Fibrinolytic Therapy for ST Elevation Myocardial Infarction

Hemorrhagic stroke (HS) is a feared complication of Fibrinolytic therapy (FT). Risk assessment scores may help in risk stratification to reduce this complication. Patients (admissions) ≥18 years with a primary diagnosis of ST-elevation myocardial infarction (STEMI) who received systemic thrombolysis were extracted from Nationwide Inpatient Sample database and stratified and compared based on CHA2DS2VASC score 0 to 3, 4 to 6, and 7 to 9 as low, intermediate and high risk, respectively. The primary outcomes of interest were HS and mortality. We performed logistic regression analysis with a composite of HS and mortality as the primary end point. Of the 917,307 admissions with a primary diagnosis of STEMI, 39,579 (4.3%) underwent FT. The median score was 3 (interquartile range 1 to 5). The rate of HS significantly increased in the risk category compared with the low and intermediate groups (0.5% and 0.6% vs 4.1%; p <0.001). Mortality increased with increasing risk category (3.8% vs 10.5% vs 20.7%; p <0.001). Compared with the low-risk group patients in the intermediate (odds ratio 2.11 95% confidence interval [CI] 1.56 to 2.85; p <0.001) and high risk groups (odds ratio 3.47 95% CI 1.68 to 7.2; p <0.001) were more likely to experience the composite end point of HS or inpatient mortality. CHA2DS2VASC score performed better at predicting mortality (area under curve 0.67, 95% CI 0.64 to 0.7; p = 0.014) than HS (area under curve 0.6 95% CI 0.52 to 0.69; p = 0.021). In conclusion, patients with high CHA2DS2VASC score (7 to 9) are at a higher risk of hemorrhagic stroke and death after FT for STEMI. CHA2DS2VASC score performed better at predicting mortality than hemorrhagic stroke in this cohort.

CORONARY ARTERY BYPASS GRAFT SURGERY AFTER ACUTE ST ELEVATION MYOCARDIAL INFARCTION: HOW EARLY IS TOO EARLY?

Background: The optimal timing of coronary artery bypass graft surgery (CABG) in patients presenting with acute ST elevation myocardial infarction (STEMI) is unclear. Methods: We reviewed the Nationwide Inpatient Survey database for all cases with a primary diagnosis of STEMI who underwent CABG

Temporal and Provincial Variation in Ambulance Use Among Patients Who Present to Acute Care Hospitals With ST-Elevation Myocardial Infarction

BackgroundAt the first sign or symptoms consistent with an ST-elevation myocardial infarction (STEMI), patients are encouraged to call 9-1-1 and activate emergency medical services immediately. We examined: (1) temporal trends and provincial variations in the proportion of STEMI patients who arrive by ambulance; and (2) the association between patient demographic and clinical characteristics and ambulance use. MethodsHospital data for all patients 20 years or older who presented with a primary diagnosis of STEMI between April 1, 2007 and March 31, 2013 in all provinces, except Quebec, were examined to identify ambulance use rates according to year and province. ResultsAmong 67,232 STEMI hospitalizations (for 66,008 unique patients), the proportion of patients who presented by ambulance increased from 60% in fiscal year (FY) 2007 to 68% in FY 2012. In FY 2012, Alberta had the highest percentage of ambulance use (76%), followed by New Brunswick (73%) and Ontario (72%). At the province level, a higher rate of ambulance use was negatively correlated (r = −0.72; P = 0.04) with in-hospital mortality rate. Patients who presented by ambulance were older and more likely to be female. Self-presenters were more likely to be urban dwellers and present during work hours. Provincial differences in ambulance use remained after adjustment for patient characteristics, overall, and within specific patient subgroups. ConclusionsThe use of ambulance services among patients who presented with STEMI in Canada has increased significantly over the past 5 years, although significant interprovincial variation remains.

Abstract 18808: Higher Short Term Mortality in Sickle Cell Patients Presenting With ST Elevation Myocardial Infarction

Introduction: Sickle cell disease (SCD) has been shown in multiple studies worldwide to be associated with considerable morbidity and mortality, including a higher risk for acute myocardial infarction (AMI). However, the effect of SCD on outcome in patients with myocardial infarction remains unclear. We sought to investigate the in-hospital mortality in patients with SCD presenting with acute ST elevation myocardial infarction (STEMI) compared to the general population. Hypothesis: Short term mortality in patients with SCD presenting with STEMI is higher when compared to the general population. Methods: The National Inpatient Sample (NIS), part of the Healthcare Cost and Utilization Project (HCUP), is the largest publicly available inpatient database designed to provide information on characteristics and outcomes of patients discharged from US hospitals. Using the NIS database, we identified 879,108 adult patients with a primary diagnosis of STEMI in the period between 1998 and 2012. Among this patient population, 52 patients also had a diagnosis of SCD. Results: Compared to the general population, patients with SCD were significantly younger (55 years vs. 66 years, p&lt;0.001), were more likely to be female (60% vs. 37%, p=0.001), and had a lower prevalence of hypertension (35% vs. 47%, p=0.06) and dyslipidemia (2% vs. 13%, p=0.02). They were less likely to undergo revascularization procedures compared to the general population (38% vs. 53%, p=0.04). The in-hospital mortality for patients with STEMI and SCD was 19.2% compared to 10.0% in patients without SCD (p=0.03). After adjusting for pertinent covariates using logistic regression analysis, SCD remained an independent predictor of higher in-hospital mortality (p=0.02, OR 2.4; 95% CI 1.1-5.1). Conclusions: Sickle cell patients have a higher in-hospital mortality compared to the general population when presenting with STEMI.

Abstract 368: Association of Atrial Fibrillation with In-hospital Outcomes in ST-Elevation Myocardial Infarction - A Propensity Matched Study

Background: Atrial fibrillation is a relatively common comorbid condition in patients with coronary artery disease. However, there are limited data on the association of atrial fibrillation (AF) with outcomes in ST-elevation myocardial infarction (STEMI). Methods: We queried the 2003-2011 Nationwide Inpatient Sample databases using the ICD-9 diagnosis codes, to identify all patients &gt; 18 years admitted with a primary diagnosis of STEMI. We studied the association of AF with in-hospital outcomes in these patients both by regression analysis and propensity match to adjust for demographics, hospital characteristics and co-morbidities. Results: Of the total 452,772 (64.5% men) STEMI hospitalizations, AF was documented in 58,273 (12.9%) cases. Patients with AF were older (mean age 75±12 vs 64±14 years; p&lt;0.001) and had a higher proportion of women (42.5% vs 34.5%; p&lt;0.001) than patients without AF. STEMI patients with AF had a higher risk-adjusted in-hospital mortality (OR 1.15, 95% CI 1.12-1.19, p&lt;0.001), longer average length of stay (7 days vs 4 days, P&lt;0.001) and higher average total hospital charges ($74,082 vs $57,331, P&lt;0.001) than those without AF. Using propensity matching, 57,388 STEMI patients with AF were compared with the same number of patients without AF. Within these matched cohorts, STEMI patients with AF had higher in-hospital mortality (16.7% vs 15.1%, OR 1.13, 95% CI 1.09-1.16; p&lt;0.001), longer average length of stay (7 days vs 6 days, P&lt;0.001), and higher average total hospital charges ($73,832 vs $65,201, P&lt;0.001) than patients without AF. Conclusions: In patients hospitalized with STEMI, AF was independently associated with modestly higher in-hospital mortality, higher hospital charges, and longer length of stay.

Percutaneous Coronary Intervention, Comorbidities, and Mortality among Emergency Department–Admitted ST‐Elevation Myocardial Infarction Patients in Florida

Risk of mortality following an ST-elevation myocardial infarction (STEMI) can be significantly reduced by prompt percutaneous coronary intervention (PCI). National guidelines specify primary PCI as the preferred recommended treatment for STEMI. In this study, we examined same-day PCI as an independent predictor of in-hospital mortality, after adjustment for comorbidities, other patient factors, and hospital PCI-volume using unselected surveillance data from Florida. We analyzed hospital discharge data for adults, 18+ years old, with a primary diagnosis of STEMI who were admitted to PCI-capable hospitals through the emergency department during 2001-2005 (n = 43,849). Hierarchical (multilevel) logistic regression models were used for analysis. Overall, 4,143 STEMI patients (9.4%) did not survive to hospital discharge. In late 2005, the in-hospital mortality rates were 1.9% for those who received same-day PCI versus 13.0% for those who did not. After adjustment for multiple patient factors, same-day PCI was a significant predictor of in-hospital survival with a strong protective effect (adjusted OR = 0.35, 95% CI 0.31-0.38 P < 0.0001). Restriction of the analysis to those patients who survived the first day of admission did not appreciably change this result (adjust OR = 0.37, 95% CI 0.33-0.42, P < 0.0001). Hospital PCI-volume did not significantly impact mortality risk. Same-day PCI markedly reduced the risk of in-hospital mortality among STEMI patients after multivariate adjustment. Serious comorbidities and complications, older age, and female gender continued to predict elevated risk of mortality after control for treatment status. Our results provide additional evidence in support of national clinical recommendations and aggressive treatment of STEMI.