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ST Elevation Myocardial Infarction Mortality Among Patients With Liver Cirrhosis: A Nationwide Analysis Across a
Marwan S Abougergi1, Raffi Karagozian, Norman D Grace
1Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Insights
Patients with cirrhosis experiencing ST elevation myocardial infarction (STEMI) have higher mortality rates. However, increased stent utilization narrowed this gap between 1999 and 2009, improving outcomes for this vulnerable group.
Area of Science:
- Cardiology
- Hepatology
- Public Health
Background:
- Mortality from ST elevation myocardial infarction (STEMI) is declining nationally.
- No prior studies have specifically examined STEMI mortality in patients with cirrhosis.
Purpose of the Study:
- To determine and compare STEMI mortality rates in patients with and without cirrhosis.
- To investigate disparities in cardiovascular interventions for these groups over a decade.
Main Methods:
- Analysis of urgent/emergent STEMI admissions from 1999 and 2009 national databases.
- Exclusion of patients under 18 or with prior liver transplantation.
- Multivariable regression analyses to account for confounders.
Main Results:
- In-hospital mortality for STEMI patients with cirrhosis was 31% (1999) and 17% (2009), versus 11% and 9% without cirrhosis.
- Adjusted mortality odds ratio decreased from 2.54 (1999) to 1.45 (2009) for patients with cirrhosis.
- Coronary stent placement increased significantly for patients with cirrhosis, from 11% to 47%.
Conclusions:
- STEMI patients with cirrhosis exhibit higher mortality compared to those without.
- The mortality gap narrowed between 1999 and 2009.
- Increased coronary artery stent utilization in cirrhosis patients likely contributed to improved outcomes.
Background:
Mortality from ST elevation myocardial infarction (STEMI) is decreasing nationwide, but no report to date examined STEMI mortality among patients with cirrhosis.
Goals:
Determine mortality rates and investigate possible disparities in cardiovascular interventions for patients with and without cirrhosis admitted with STEMI across a decade using a national database.
Study:
We included all urgent/emergent admissions with STEMI to acute care hospitals across the United States in 1999 and 2009. Exclusion criteria were age less than 18 years or prior liver transplantation. Confounders were accounted for using multivariable regression analyses.
Results:
A total of 325,857 and 182,491 patients with STEMI were included in 1999 and 2009, respectively, 741 and 541 of whom had cirrhosis, respectively. In-hospital mortality rate was 31% and 11% for patients with and without cirrhosis in 1999, and 17% and 9% in 2009. The adjusted mortality odds ratio was 2.54 (1.52 to 4.24) in 1999 and 1.45 (0.73 to 2.86) in 2009. Stent placement rate was 11% and 26% for patients with and without cirrhosis in 1999, and increased to 47% and 61% in 2009, respectively. Thrombolytic medication injection rate was 3% and 10% for patients with and without cirrhosis in 1999, and 0% and 2% in 2009, respectively. Coronary artery bypass graft surgery rate was 3% and 9% for patients with and without cirrhosis in 1999, and was 6% and 7% in 2009, respectively.
Conclusions:
STEMI mortality in patients with cirrhosis is higher compared with patients without cirrhosis. However, this mortality difference declined from 1999 to 2009, likely because of higher coronary artery stent utilization for patients with cirrhosis.
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