Impact of concomitant aortic stenosis on the management and outcomes of acute myocardial infarction hospitalizations in the United States
Objective: To evaluate the prevalence, management and outcomes of concomitant aortic stenosis (AS) in admissions with acute myocardial infarction (AMI). Methods: We used the HCUP-NIS database (2000–2017) to identify adult AMI admissions with concomitant AS. Outcomes of interest included prevalence o...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-11-01
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| Series: | American Heart Journal Plus |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666602222001343 |
| _version_ | 1811231848732295168 |
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| author | Sri Harsha Patlolla Muhammad Haisum Maqsood P. Matthew Belford Arnav Kumar Alexander G. Truesdell Pinak B. Shah Mandeep Singh David R. Holmes, Jr David X. Zhao Saraschandra Vallabhajosyula |
| author_facet | Sri Harsha Patlolla Muhammad Haisum Maqsood P. Matthew Belford Arnav Kumar Alexander G. Truesdell Pinak B. Shah Mandeep Singh David R. Holmes, Jr David X. Zhao Saraschandra Vallabhajosyula |
| author_sort | Sri Harsha Patlolla |
| collection | DOAJ |
| description | Objective: To evaluate the prevalence, management and outcomes of concomitant aortic stenosis (AS) in admissions with acute myocardial infarction (AMI). Methods: We used the HCUP-NIS database (2000–2017) to identify adult AMI admissions with concomitant AS. Outcomes of interest included prevalence of AS, in-hospital mortality, use of cardiac procedures, hospitalization costs, length of stay, and discharge disposition. Results: Among a total of 11,622,528 AMI admissions, 513,688 (4.4 %) were identified with concomitant AS. Adjusted temporal trends revealed an increase in STEMI and NSTEMI hospitalizations with concomitant AS. Compared to admissions without AS, those with AS were on average older, of female sex, had higher comorbidity, higher rates of NSTEMI (78.9 % vs 62.1 %), acute non-cardiac organ failure, and cardiogenic shock. Concomitant AS was associated with significantly lower use of coronary angiography (45.5 % vs 64.4 %), percutaneous coronary intervention (20.1 % vs 42.5 %), coronary atherectomy (1.7 % vs. 2.8 %) and mechanical circulatory support (3.5 % vs 4.8 %) (all p < 0.001). Admissions with AS had higher rates of coronary artery bypass surgery and surgical aortic valve replacement (5.9 % vs 0.1 %) compared to those without AS. Admissions with AMI and AS had higher in-hospital mortality (9.2 % vs. 6.0 %; adjusted OR 1.12 [95 % CI 1.10–1.13]; p < 0.001). Concomitant AS was associated with longer hospital stay, more frequent palliative care consultations and less frequent discharges to home. Conclusions: In this 18-year study, an increase in prevalence of AS in AMI hospitalization was noted. Concomitant AS was associated with lower use of guideline-directed therapies and worse clinical outcomes among AMI admissions. |
| first_indexed | 2024-04-12T10:51:58Z |
| format | Article |
| id | doaj.art-5684d83638424465be0c21cbd5dd4755 |
| institution | Directory Open Access Journal |
| issn | 2666-6022 |
| language | English |
| last_indexed | 2024-04-12T10:51:58Z |
| publishDate | 2022-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Heart Journal Plus |
| spelling | doaj.art-5684d83638424465be0c21cbd5dd47552022-12-22T03:36:11ZengElsevierAmerican Heart Journal Plus2666-60222022-11-0123100217Impact of concomitant aortic stenosis on the management and outcomes of acute myocardial infarction hospitalizations in the United StatesSri Harsha Patlolla0Muhammad Haisum Maqsood1P. Matthew Belford2Arnav Kumar3Alexander G. Truesdell4Pinak B. Shah5Mandeep Singh6David R. Holmes, Jr7David X. Zhao8Saraschandra Vallabhajosyula9Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, United States of AmericaDepartment of Medicine, Lincoln Medical Center, The Bronx, NY, United States of AmericaSection of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States of AmericaDivision of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of AmericaVirginia Heart/Inova Heart and Vascular Institute, Falls Church, VA, United States of AmericaDivision of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of AmericaDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of AmericaDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of AmericaSection of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States of AmericaSection of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America; Corresponding author at: Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, 306 Westwood Avenue, Suite 401, High Point, NC 27262, United States of America.Objective: To evaluate the prevalence, management and outcomes of concomitant aortic stenosis (AS) in admissions with acute myocardial infarction (AMI). Methods: We used the HCUP-NIS database (2000–2017) to identify adult AMI admissions with concomitant AS. Outcomes of interest included prevalence of AS, in-hospital mortality, use of cardiac procedures, hospitalization costs, length of stay, and discharge disposition. Results: Among a total of 11,622,528 AMI admissions, 513,688 (4.4 %) were identified with concomitant AS. Adjusted temporal trends revealed an increase in STEMI and NSTEMI hospitalizations with concomitant AS. Compared to admissions without AS, those with AS were on average older, of female sex, had higher comorbidity, higher rates of NSTEMI (78.9 % vs 62.1 %), acute non-cardiac organ failure, and cardiogenic shock. Concomitant AS was associated with significantly lower use of coronary angiography (45.5 % vs 64.4 %), percutaneous coronary intervention (20.1 % vs 42.5 %), coronary atherectomy (1.7 % vs. 2.8 %) and mechanical circulatory support (3.5 % vs 4.8 %) (all p < 0.001). Admissions with AS had higher rates of coronary artery bypass surgery and surgical aortic valve replacement (5.9 % vs 0.1 %) compared to those without AS. Admissions with AMI and AS had higher in-hospital mortality (9.2 % vs. 6.0 %; adjusted OR 1.12 [95 % CI 1.10–1.13]; p < 0.001). Concomitant AS was associated with longer hospital stay, more frequent palliative care consultations and less frequent discharges to home. Conclusions: In this 18-year study, an increase in prevalence of AS in AMI hospitalization was noted. Concomitant AS was associated with lower use of guideline-directed therapies and worse clinical outcomes among AMI admissions.http://www.sciencedirect.com/science/article/pii/S2666602222001343Aortic stenosisAcute myocardial infarctionMortalityOutcomes researchGeriatric cardiology |
| spellingShingle | Sri Harsha Patlolla Muhammad Haisum Maqsood P. Matthew Belford Arnav Kumar Alexander G. Truesdell Pinak B. Shah Mandeep Singh David R. Holmes, Jr David X. Zhao Saraschandra Vallabhajosyula Impact of concomitant aortic stenosis on the management and outcomes of acute myocardial infarction hospitalizations in the United States American Heart Journal Plus Aortic stenosis Acute myocardial infarction Mortality Outcomes research Geriatric cardiology |
| title | Impact of concomitant aortic stenosis on the management and outcomes of acute myocardial infarction hospitalizations in the United States |
| title_full | Impact of concomitant aortic stenosis on the management and outcomes of acute myocardial infarction hospitalizations in the United States |
| title_fullStr | Impact of concomitant aortic stenosis on the management and outcomes of acute myocardial infarction hospitalizations in the United States |
| title_full_unstemmed | Impact of concomitant aortic stenosis on the management and outcomes of acute myocardial infarction hospitalizations in the United States |
| title_short | Impact of concomitant aortic stenosis on the management and outcomes of acute myocardial infarction hospitalizations in the United States |
| title_sort | impact of concomitant aortic stenosis on the management and outcomes of acute myocardial infarction hospitalizations in the united states |
| topic | Aortic stenosis Acute myocardial infarction Mortality Outcomes research Geriatric cardiology |
| url | http://www.sciencedirect.com/science/article/pii/S2666602222001343 |
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