Hospitalizations for Acute Myocardial Infarction Among Patients with Celiac Disease Using a National Inpatient Database

Naaraayan, Ashutossh

Background
Celiac disease (CeD) is a systemic autoimmune condition with predominantly gastrointestinal manifestations (AI-GI). Autoimmune conditions with systemic manifestations (AI-S) such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and polymyositis (PM) are present at a higher frequency in patients with CeD than in general population. The risk of coronary artery disease (CAD) and myocardial infarction (MI) is greatly increased in patients with AI-S. On the contrary, patients with AI-GI such as inflammatory bowel disease, have been shown to have decreased risk of MI. We aim to describe the incidence of MI related hospitalizations and outcomes in patients with CeD.

Methods
A descriptive, retrospective study was conducted on the National Inpatient Sample (NIS) database for the years 2005-2014. Admissions with age greater than 18 years and CeD were selected based on International Classification of Diseases-Ninth Revision, Clinical Modification diagnoses code (5790). Patients with SLE, RA and PM and primary diagnosis of MI (PMI) were identified using appropriate codes.

Results
From 2005 and 2014, there was no significant change in PMI related hospitalizations in patients with CeD. Median age of CeD patients with PMI was 70.15 + 13.08 years and 52.19% were female. The adjusted odds of PMI [OR 0.78, CI (0.72-0.86), p<0.001] and CAD [OR 0.95, CI (0.92-0.99), p<0.007] in patients with CeD was significantly lower than in the general population (GP). ST-elevation MI accounted for 26.82% of the PMI-CeD. Of the PMI patients with CeD, 41.07% underwent percutaneous coronary intervention and 8.92% underwent coronary-bypass. The adjusted odds of mortality from PMI was significantly lower in patients with CeD when compared to GP [OR 0.33, CI (0.19-0.57), p<0.001]. Among patients with AI-S (SLE, RA or PM), the odds of having PMI was significantly lower in patients with AI-S and concomitant CeD when compared to patients with AI-S without CeD.

Conclusions
The risk of PMI and CAD is significantly lower in patients with CeD. This “protective” effect of CeD was even more evident as the risk of PMI was lower in patients with AIS and CeD when compared to AIS without CeD.