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Published on: October 14, 2016
Outcomes of Acute Myocardial Infarction in Heart Transplant Recipients
Tariq Enezate1, Jad Omran2, Patricia P Chang3
1Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri.
Insights
Heart transplant recipients experiencing acute myocardial infarction (AMI) face longer hospital stays and higher morbidity. Despite this, their in-hospital mortality risk is similar to the general population, though they receive less invasive treatment.
Area of Science:
- Cardiology
- Transplantation Medicine
- Health Services Research
Background:
- Heart transplantation (HT) recipients are a growing population with unique cardiovascular risks.
- Coronary artery disease is a significant cause of morbidity in HT patients, but outcomes following acute myocardial infarction (AMI) in this group compared to the general population are not well-defined.
Purpose of the Study:
- To compare the in-hospital outcomes of acute myocardial infarction (AMI) in heart transplantation (HT) recipients versus non-HT patients.
- To analyze differences in mortality, length of stay, complications, invasive procedures, and readmission rates.
Main Methods:
- Retrospective analysis of the National Readmissions Data from 2014.
- Identification of patients with AMI, stratified by history of HT.
- Comparison of outcomes including in-hospital mortality, length of stay (LOS), cardiogenic shock, acute kidney injury, cardiac catheterization with/without percutaneous coronary intervention (PCI), and 30-day readmission rates.
Main Results:
- The HT group (789 patients) experienced longer LOS (5.9 vs 4.9 days), higher rates of cardiogenic shock (8.8% vs 6.4%), and acute kidney injury (26.2% vs 17.6%) compared to non-HT patients (259,794 patients).
- HT recipients were less likely to receive cardiac catheterization (59.7% vs 75.1%) and percutaneous coronary intervention (PCI) (35.2% vs 50.0%).
- The 30-day readmission rate was significantly higher in the HT group (21.3% vs 14.4%), with no significant difference in all-cause in-hospital mortality (6.8% vs 5.4%).
Conclusions:
- Heart transplantation recipients with AMI exhibit increased in-hospital morbidity, longer hospital stays, and higher 30-day readmission rates compared to non-HT patients.
- HT patients with AMI are less likely to undergo invasive procedures like PCI.
- Despite increased morbidity and lower intervention rates, all-cause in-hospital mortality remains similar between HT recipients and the general population following AMI.
Abstract:
Heart transplantation (HT) recipients represent a growing patient population. Although mechanisms might differ, coronary artery disease is an important cause of morbidity in this group. Limited data are available on the outcomes of acute myocardial infarction (AMI) in HT in comparison to general population (non-HT). The study population was extracted from the National Readmissions Data 2014 using International Classification of Diseases, Ninth Revision, Clinical Modification codes for AMI and HT. The study outcomes included in-hospital all-cause mortality, length of hospital stay (LOS), cardiogenic shock, acute kidney injury, the likelihood of receiving invasive left-sided cardiac catheterization with and/or without percutaneous coronary intervention (PCI) and 30-day readmission rates. A total of 259,794 discharges with a principal diagnosis of AMI were identified, in which 789 had a history of HT. In comparison to non-HT, HT group was associated with longer LOS (5.9 vs 4.9 days, p <0.01), more cardiogenic shock (8.8% vs 6.4%, p <0.01), more acute kidney injury (26.2% vs 17.6%, p <0.01), less catheterization (59.7% vs 75.1%, p <0.01), less use of PCI (35.2% vs 50.0%, p <0.01), and higher 30-day readmission rate (21.3% vs 14.4%, p <0.01). However, there was no statistically significant difference in all-cause mortality (6.8% vs 5.4%, p = 0.07). In conclusion, compared with non-HT, HT with AMI was associated with longer LOS, more in-hospital morbidity, lower likelihood of receiving invasive treatment (including PCI), and higher 30-day readmission rates. There was no significant difference in all-cause mortality.
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