Author + information
- Parasuram Krishnamoorthy1,
- Akshaya Gopalakrishnan1,
- Jalaj Garg2,
- Janani Rangaswami1,
- Sanjog Kalra1,
- Vincent Figueredo1 and
- D. Lynn Morris3
There is paucity of data on the prevalence and clinical outcomes of Acute Myocardial infarction (AMI) in patients with liver cirrhosis. With increase in the prevalence of nonalcoholic steatohepatitis (NASH) which shares common risk factors for coronary artery disease, we aimed to describe the prevalence and outcome of AMI in patients with liver cirrhosis.
We utilized the National Inpatient Sample (NIS) from 2005 to 2010 to examine the trends in prevalence and clinical outcomes of AMI in cirrhotic patients. All patients greater than 18 years of age with a primary diagnosis of AMI were extracted using ICD-9 codes 410.xx. Patients with liver cirrhosis were identified using ICD-9 codes 571.xx. Demographic and cardiac risk factors were extracted. Primary outcome was in hospital mortality and secondary outcomes were length of hospital stay and cost of hospitalization.
A total of 777,980 hospitalizations were identified with a principal discharge diagnosis of AMI, representing an estimated 3,845,199 hospitalizations in the United States from 2005 to 2010 out of which 14,612 (0.38%) patients had liver cirrhosis. The overall prevalence of cirrhosis increased from 0.17% (n=1,095) in 2005 to 0.39% (n=2,357) in 2010 (Ptrend<0.001). Cirrhotic patients underwent less percutaneous coronary interventions (22% vs 42%; P<0.0001), less thrombolytic agents infusion (0.5% vs 1.5%; p<0.0001) and less coronary artery bypass grafting (5.4% vs 9%; p<0.0001) compared to patients with no cirrhosis. However, the number of percutaneous coronary interventions increased from 19% in 2005 vs 24% in 2010 (p<0.001) in cirrhotic patients with AMI. Overall in-hospital mortality was high in cirrhotic patients (13.5% vs 6%; p<0.0001) compared to patients with no liver cirrhosis. However, in-hospital mortality decreased from 14.5% in 2005 to 12.1% in 2010 in cirrhotic patients with AMI (p=0.003). Cirrhotic patients with AMI had longer hospital days (7.1±0.1 vs 5.1±0.1; p<0.001) and increased hospitalization costs ($65,110 ±$1,529 vs $56,881.1±76; p<0.001) compared to patients without liver cirrhosis.
Presence of liver cirrhosis was associated with increased in-hospital mortality, longer hospital stays and higher hospitalization costs in patients with acute myocardial infarction.
CORONARY: Acute Myocardial Infarction