Author + information
- Akinniran Abisogun,
- Anthony Mazzella,
- Melissa Caughey and
- Xuming Dai
Background: Invasive therapy (IT) with coronary angiography and percutaneous coronary intervention is generally recommended for non ST elevation myocardial infarction (NSTEMI). The outcomes of patients who develop NSTEMI while hospitalized for non-cardiac conditions (inpatient NSTEMI) receiving IT have not been well defined. This study compares outcomes after invasive management between inpatient and outpatient onset NSTEMI patients, to identify associated determining factors.
Methods: This single-center retrospective study queried the adult hospital discharge database with AMI ICD-9 code and “not present on admission” modifier and reviewed the local CathPCI registry to identify inpatient NSTEMI and outpatient NSTEMI patients who underwent invasive management from February 2008 through April 2014 at the University of North Carolina Hospitals. Demographics, medical history, management and outcomes information were collected. In-hospital mortality and length of stay (LOS) were analyzed using multivariable logistic regression and multiple linear regression, respectively. Models were adjusted for demographics and comorbidities or procedures associated with NSTEMI presentation status in unadjusted analyses.
Results: 843 invasively managed NSTEMIs (99 inpatient, and 734 outpatient) were identified. Compared to outpatient NSTEMI, inpatient NSTEMI had higher rate of prior percutaneous intervention or coronary artery bypass graft, chronic kidney disease and peripheral artery disease. Inpatient onset NSTEMI had a significantly higher adjusted in-hospital mortality (odds ratio [OR]: 3.3; 95% confidence interval [CI]: (CI 1.2 to 8.7; p = 0.02), and longer LOS (8.6 days longer, 95% CI 7.9 to 9.9). Inpatient and outpatient NSTEMI had the same rate of revascularization after diagnostic angiography (50% vs 50%; p=0.3). Undergoing revascularization did not affect mortality (OR: 1.1, 95% CI 0.7 to 1.7).
Conclusions: In patients managed invasively, inpatient onset NSTEMIs had higher adjusted in-hospital mortality, and longer LOS compared to those of outpatient NSTEMI. Admission status did not affect the rate of revascularization.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Interventional Cardiology: PCI in Complex Patients
Abstract Category: 19. Interventional Cardiology: Complex Patients/Comorbidities
Presentation Number: 1287-187
- 2017 American College of Cardiology Foundation