Author + information
- Anthony J. Mazzella,
- Akinniran Abisogun,
- Melissa Caughey and
- Xuming Dai
Background: Patients hospitalized for non-cardiac conditions often experience increased levels of stress and hemodynamic challenges thus making them susceptible to acute coronary events. Elevated troponin is associated with mortality in peri-operative patients but there is a paucity of data in non-surgical patients. Recent studies revealed delayed treatment and worse outcomes for hospitalized patients who developed ST-elevation myocardial infarction (inpatient STEMI). However, clinical features, management strategy, and outcomes of inpatient non-ST elevation myocardial infarction (NSTEMI) have not been described.
Methods: This single-center retrospective study identified patients with inpatient NSTEMI from the University of North Carolina Hospitals discharge database between February 2008 and April 2014 by using ICD-9 codes 410.00 through 410.92 and including a “not present on admission” modifier, signifying acute myocardial infarction after admission. 485 cases were identified and manually reviewed. In-hospital mortality and length of stay were analyzed using multivariable and multiple linear regression, respectively.
Results: A total of 302 patients were confirmed to have inpatient NSTEMI with 154 patients admitted to surgical and 148 admitted to medical services. In-hospital mortality of inpatient NSTEMI is high (19%). Patients with inpatient NSTEMI who underwent cardiac catheterization had lower in-hospital mortality than those who did not (6% versus 25%; adjusted odds ratio: 0.19; 95% confidence interval [CI]: 0.07 to 0.50) and were discharged 7.9 days earlier (95% CI: 2.4 to 12.3 days). Inpatient NSTEMIs on surgical services when compared to medical services were more likely to generate cardiology consultation (96% versus 62%, p < 0.0001) and left heart catheterization (41% versus 24%, p = 0.002). After diagnostic coronary angiography, medical and surgical patients had comparable rate of revascularization (56% versus 56%, p = 1.0).
Conclusions: Patients hospitalized for non-cardiac conditions that develop NSTEMI have high in-hospital mortality. Invasive management is associated with lower adjusted in-hospital mortality rates and shorter length of stays.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: PCI for NSTEMI and Complex Patients With Multiple Co-Morbidities
Abstract Category: 19. Interventional Cardiology: Complex Patients/Comorbidities
Presentation Number: 1154-147
- 2017 American College of Cardiology Foundation