Outcomes Associated With NSTEMI In Patients With Cirrhosis: Analysis Of The National Inpatient Sample 2016-2018
Presenter
Aditya Mantha, M.D., Cleveland Clinic Main Campus, Cleveland, OH
Aditya Mantha, M.D., Cleveland Clinic Main Campus, Cleveland, OH, Akash Rusia, M.D., Beaumont Health, Royal Oak, MI, Sati Patel, M.D., Henry Ford Hospital, Detroit, IL, Daniel Miklin, M.D., Northwell Health North Shore University Hospital, Manahsset, NY, Ali K Ashtiani, M.D., The University of California, Irvine Medical Center, Irvine, CA and Ihab Alomari, M.D., FSCAI, Providence Mission Hospital , Anaheim, CA
Keywords: Acute Coronary Syndromes (ACS) and Complications
Background
Cirrhosis profoundly impacts coagulation, alters hemodynamics and induces inflammation in patients with cardiovascular disease. However, the impact of cirrhosis on outcomes and resource utilization in non-ST segment myocardial infarction (NSTEMI) remains less clear. Methods
Patients primarily admitted for NSTEMI in the 2016-2018 National Inpatient Sample (NIS) were identified using the ICD-10 classification. The NIS is an all-payer, inpatient database estimating 37 million annual U.S. hospitalizations. Multivariate hierarchical regression analysis was used to adjust clinical outcomes for demographics, comorbidities and complications. Results
Of 1,405,589 patients admitted for NSTEMI, 12,150 had cirrhosis. Cirrhotic patients were more likely male (64.2% vs 59.8%, P<0.001) and Hispanic (12.4% vs 8.7%, P<0.001). Utilization of percutaneous coronary intervention (PCI) (23.9% vs 35.7%, P<0.001) and drug-eluting stents (20.0 vs 33.2%, P<0.001) were lower among cirrhotics. Cirrhotic patients had higher rates of gastrointestinal hemorrhage (8.6% vs 2.4%, P<0.001) thrombocytopenia (30.4% vs 5.1%, P<0.001) and cardiogenic shock (5.1% vs 3.6%, P<0.001), and required more transfusions (12.8% vs 5.7%, P<0.001) and ventilation (9.6% vs 7.2%, P<0.001). The use of mechanical circulatory support was similar (4.2% vs 3.3%, P=0.017) among both groups. Cirrhosis was associated with an increased adjusted all-cause mortality (6.5% vs 3.4%, aOR: 1.53, P<0.001). Conclusions
The presence of cirrhosis significantly increases the complications and mortality among patients admitted for NSTEMI despite lower rates of percutaneous revascularization. These results support the integration of comorbid liver disease in risk stratification and assessment in NSTEMI.