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Hsiao BY. Sjogren Syndrome and Outcomes of Acute Myocardial Infarction: A Propensity Score-Matched Analysis of the Nationwide Inpatient Sample 2005-2018. J Cardiovasc Pharmacol 2024; 84:394-399. [PMID: 39027977 DOI: 10.1097/fjc.0000000000001603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/04/2024] [Indexed: 07/20/2024]
Abstract
ABSTRACT The aim of this study was to evaluate the potential associations between Sjogren syndrome and outcomes of acute myocardial infarction (AMI) hospitalization. This population-based, retrospective observational study extracted data from the US Nationwide Inpatient Sample between 2005 and 2018. Adults aged 20 years or older hospitalized for AMI were eligible for inclusion. Propensity score matching was applied to balance the characteristics between the comparison groups (ie, with and without Sjogren syndrome). Associations between Sjogren syndrome and in-hospital outcomes were determined using univariate and multivariable logistic regression analyses. A total of 1,735,142 patients were included. After propensity score matching, 4740 patients remained for subsequent analyses (948 had Sjogren syndrome and 3792 did not). After adjustment, patients with Sjogren syndrome had significantly lower in-hospital mortality (adjusted OR: 0.52, 95% CI, 0.36-0.73, P < 0.001), prolonged length of stay (aOR: 0.83, 95% CI, 0.69-0.995, P = 0.044), cardiogenic shock (aOR: 0.58, 95% CI, 0.40-0.83, P = 0.004), cardiac dysrhythmias (aOR: 0.77, 95% CI, 0.66-0.90, P < 0.001), acute kidney injury (aOR: 0.56, 95% CI, 0.45-0.70, P < 0.001), or respiratory failure (aOR: 0.63, 95% CI, 0.48-0.81, P < 0.001) than those without Sjogren syndrome. The stratified analysis revealed that Sjogren syndrome was associated with decreased odds of in-hospital mortality in patients with non-ST elevation myocardial infarction or ST-elevation myocardial infarction. In conclusion, among patients admitted to US hospitals for AMI, the patients with Sjogren syndrome have a lowered probability of in-hospital mortality, certain morbidities, and prolonged length of stay. Further investigations should be conducted to establish a robust understanding of the associations observed.
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Affiliation(s)
- Bu-Yuan Hsiao
- Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; and
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
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2
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Abdul Jabbar AB, Ismayl M, Mishra A, Walters RW, Goldsweig AM, Aronow HD, Tauseef A, Aboeata AS. Outcomes of Acute Myocardial Infarction in Patients With Systemic Lupus Erythematosus: A Propensity-Matched Nationwide Analysis. Am J Cardiol 2024; 233:7-10. [PMID: 39312991 DOI: 10.1016/j.amjcard.2024.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Revised: 09/05/2024] [Accepted: 09/10/2024] [Indexed: 09/25/2024]
Affiliation(s)
- Ali Bin Abdul Jabbar
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska.
| | - Mahmoud Ismayl
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Anjali Mishra
- Creighton University School of Medicine, Omaha, Nebraska
| | - Ryan W Walters
- Department of Clinical Research and Public Health, Creighton University School of Medicine, Omaha, Nebraska
| | - Andrew M Goldsweig
- Department of Cardiovascular Medicine, Baystate Medical Center and Division of Cardiology, University of Massachusetts-Baystate, Springfield, Massachusetts
| | - Herbert D Aronow
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan; Michigan State University College of Human Medicine, East Lansing, Michigan
| | - Abubakar Tauseef
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Ahmed S Aboeata
- Department of Cardiology, Creighton University School of Medicine, Omaha, Nebraska
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3
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Antia A, Aomreore K, Udongwo N, Menon S, Ibebuogu U. In-hospital outcomes and trends of patients with autoimmune diseases undergoing percutaneous coronary intervention: A nationwide analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 65:37-43. [PMID: 38531708 DOI: 10.1016/j.carrev.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/21/2024] [Accepted: 02/26/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND The risk of coronary artery disease is exaggerated in patients with autoimmune diseases (AID). A higher risk of complications has been reported during and after percutaneous coronary intervention (PCI) in these patients. We aimed to analyze the in-hospital outcomes and trends of patients with AID, including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and inflammatory bowel disease (IBD) undergoing PCI. METHOD We identified all PCI procedures using the National In-patient Sample database from 2016 to 2020. Stratified them into cohorts with RA, SLE and IBD and compared them to cohorts without AID. The Chi-square test and multivariate logistic regression were used for analysis. A p-value <0.005 was considered statistically significant. RESULT We identified 2,367,475 patients who underwent PCI. Of these, 1.6 %, 0.5 %, and 0.4 % had RA, IBD and SLE respectively. The odds of mortality were lower among patients with IBD (aOR: 0.56; CI 0.38-0.81, p = 0.002) but patients with RA had higher odds of having composite major complications [(MC) including cerebrovascular accident (CVA), cardiac arrest, acute heart failure (AHF), ventricular arrhythmia (VA), major bleeding, and acute kidney injury (AKI)] (aOR: 0.90; CI 0.83-0.98, p = 0.013). Our SLE cohort had higher rates of CVA (p = 0.017) and AKI (p = 0.002). Our cohort with IBD had lower rates of cardiac arrest but had longer hospital length of stay (4.9 days vs 3.9 days) and they incurred higher hospital charges compared to cohort without IBD. CONCLUSION This study depicts the immediate adverse outcomes observed in patients with AID undergoing PCI. In contrast to those without AID, our cohorts with RA exhibited worse outcomes, as indicated by the higher odds of major complications. IBD is associated with lower risks of in-hospital adverse outcomes but with higher resource utilization.
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Affiliation(s)
- Akanimo Antia
- Department of Medicine, Lincoln Medical Center, Bronx, NY, United States of America.
| | - Kessiena Aomreore
- Department of Medicine, Lincoln Medical Center, Bronx, NY, United States of America
| | - Ndausung Udongwo
- Department of Medicine, Division of Cardiovascular Medicine, Morehouse School of Medicine, Atlanta, GA, United States of America
| | - Sharika Menon
- Department of Medicine, Division of Rheumatology, Lincoln Medical Center, Bronx, NY, United States of America
| | - Uzoma Ibebuogu
- Department of Medicine, Division of Cardiovascular Medicine, University of Tennessee Health Science Center, Memphis, TN, United States of America
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Mason KJ, Jordan KP, Heron N, Edwards JJ, Bailey J, Achana FA, Chen Y, Frisher M, Huntley AL, Mallen CD, Mamas MA, Png ME, Tatton S, White S, Marshall M. Musculoskeletal pain and its impact on prognosis following acute coronary syndrome or stroke: A linked electronic health record cohort study. Musculoskeletal Care 2023; 21:749-762. [PMID: 36853885 DOI: 10.1002/msc.1748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVE Musculoskeletal painful conditions are a risk factor for cardiovascular disease (CVD), but less is known about whether musculoskeletal pain also worsens prognosis from CVD. The objective was to determine whether patients with musculoskeletal pain have poorer prognosis following acute coronary syndrome (ACS) or stroke. METHODS The study utilised UK electronic primary care records (CPRD Aurum) with linkage to hospital and mortality records. Patients aged ≥45 years admitted to hospital with incident ACS/stroke were categorised by healthcare use for musculoskeletal pain (inflammatory conditions, osteoarthritis [OA], and regional pain) based on primary care consultations in the prior 24 months. Outcomes included mortality, length of stay, readmission and management of index condition (ACS/stroke). RESULTS There were 171,670 patients with incident ACS and 138,512 with stroke; 30% consulted for musculoskeletal pain prior to ACS/stroke and these patients had more comorbidity than those without musculoskeletal pain. Rates of mortality and readmission, and length of stay were higher in those with musculoskeletal pain, particularly OA and inflammatory conditions, in ACS. Readmission was also higher for patients with musculoskeletal pain in stroke. However, increased risks associated with musculoskeletal pain did not remain after adjustment for age and polypharmacy. Inflammatory conditions were associated with increased likelihood of prescriptions for dual anti-platelets (ACS only) and anti-coagulants. CONCLUSIONS Patients with musculoskeletal pain have higher rates of poor outcome from ACS which relates to being older but also increased polypharmacy. The high rates of comorbidity including polypharmacy highlight the complexity of patients with musculoskeletal pain who have new onset ACS/stroke.
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Affiliation(s)
- Kayleigh J Mason
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Kelvin P Jordan
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Neil Heron
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - John J Edwards
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - James Bailey
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Felix A Achana
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
| | - Ying Chen
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
- Academy of Pharmacy, Xi'an Jiaotong - Liverpool University, Suzhou, China
| | - Martin Frisher
- School of Pharmacy and Bioengineering, Keele University, Keele, UK
| | - Alyson L Huntley
- Centre for Academic Primary Care, Bristol Medical School, Bristol University, Bristol, UK
| | - Christian D Mallen
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, UK
| | - May Ee Png
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
| | - Stephen Tatton
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Simon White
- School of Pharmacy and Bioengineering, Keele University, Keele, UK
| | - Michelle Marshall
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
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Wassif H, Saad M, Desai R, Hajj‐Ali RA, Menon V, Chaudhury P, Nakhla M, Puri R, Prasada S, Reed GW, Ziada K, Kapadia S, Desai M, Mentias A. Outcomes Following Acute Coronary Syndrome in Patients With and Without Rheumatic Immune‐Mediated Inflammatory Diseases. J Am Heart Assoc 2022; 11:e026411. [DOI: 10.1161/jaha.122.026411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Rheumatic immune mediated inflammatory diseases (IMIDs) are associated with high risk of acute coronary syndrome. The long‐term prognosis of acute coronary syndrome in patients with rheumatic IMIDs is not well studied.
Methods and Results
We identified Medicare beneficiaries admitted with a primary diagnosis of myocardial infarction (MI) from 2014 to 2019. Outcomes of patients with MI and concomitant rheumatic IMIDs including systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, dermatomyositis, or psoriasis were compared with propensity matched control patients without rheumatic IMIDs. One‐to‐three propensity‐score matching was done for exact age, sex, race, ST‐segment–elevation MI, and non–ST‐segment–elevation MI variables and greedy approach on other comorbidities. The study primary outcome was all‐cause mortality. The study cohort included 1 654 862 patients with 3.6% prevalence of rheumatic IMIDs, the most common of which was rheumatoid arthritis, followed by systemic lupus erythematosus. Patients with rheumatic IMIDs were younger, more likely to be women, and more likely to present with non–ST‐segment–elevation MI. Patients with rheumatic IMIDs were less likely to undergo coronary angiography, percutaneous coronary intervention or coronary artery bypass grafting. After propensity‐score matching, at median follow up of 24 months (interquartile range 9–45), the risk of mortality (adjusted hazard ratio [HR], 1.15 [95% CI, 1.14–1.17]), heart failure (HR, 1.12 [95% CI 1.09–1.14]), recurrent MI (HR, 1.08 [95% CI 1.06–1.11]), and coronary reintervention (HR, 1.06 [95% CI, 1.01–1.13]) (
P
<0.05 for all) was higher in patients with versus without rheumatic IMIDs.
Conclusions
Patients with MI and rheumatic IMIDs have higher risk of mortality, heart failure, recurrent MI, and need for coronary reintervention during follow‐up compared with patients without rheumatic IMIDs.
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Affiliation(s)
- Heba Wassif
- Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Marwan Saad
- Lifespan Cardiovascular Institute Providence RI
- Department of Medicine, Division of Cardiovascular Medicine, Warren Alpert Medical School of Brown University Providence RI
| | - Rajul Desai
- Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Rula A. Hajj‐Ali
- Department of Rheumatic and Immunologic Disease Cleveland Clinic Cleveland OH
| | - Venu Menon
- Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Pulkit Chaudhury
- Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Michael Nakhla
- Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Rishi Puri
- Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Sameer Prasada
- Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Grant W. Reed
- Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Khaled Ziada
- Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Samir Kapadia
- Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Milind Desai
- Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Amgad Mentias
- Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
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Influence of the Danish Co-morbidity Index Score on the Treatment and Outcomes of 2.5 Million Patients Admitted With Acute Myocardial Infarction in the United States. Am J Cardiol 2022; 179:1-10. [PMID: 35843732 DOI: 10.1016/j.amjcard.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 11/20/2022]
Abstract
This study aimed to determine the association between the Danish Co-morbidity Index for Acute Myocardial Infarction (DANCAMI) and restricted DANCAMI (rDANCAMI) scores and clinical outcomes in patients hospitalized with AMI. Using the National Inpatient Sample, all AMI hospitalizations were stratified into four groups based on their DANCAMI and rDANCAMI score (0; 1 to 3; 4 to 5; ≥6). The primary outcome was all-cause mortality, whereas secondary outcomes were major adverse cardiovascular/cerebrovascular events, major bleeding, ischemic stroke, and receipt of coronary angiography or percutaneous coronary intervention. Multivariate logistic regression was used to determine adjusted odds ratios (aOR) with 95% confidence intervals (95% CIs). Patients with DANCAMI risk score ≥6 were more likely to suffer mortality (aOR 2.30, 95% CI 2.24 to 2.37) and bleeding (aOR 5.85, 95% CI 5.52 to 6.21) and were less likely to receive coronary angiography (aOR 0.34, 95% CI 0.33 to 0.34) and percutaneous coronary intervention (aOR 0.29, 95% CI 0.28 to 0.29) compared with patients with DANCAMI score of 0. Similar results were observed for the rDANCAMI score. In conclusion, increased DANCAMI and rDANCAMI scores were associated with worse in-hospital outcomes in patients with AMI and lower odds of invasive management. The use of co-morbidity scores identifies patients at high risk of adverse outcomes and highlights disparities in care.
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Sokhal BS, Matetić A, Bharadwaj A, Helliwell T, Abhishek A, Mallen CD, Mohamed MO, Mamas MA. Treatment and Outcomes of Acute Myocardial Infarction in Patients With Polymyalgia Rheumatica With and Without Giant Cell Arteritis. Am J Cardiol 2022; 174:12-19. [PMID: 35473781 DOI: 10.1016/j.amjcard.2022.03.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/26/2022]
Abstract
This study analyzed the characteristics, management, and outcomes of patients with polymyalgia rheumatica (PMR) hospitalized with acute myocardial infarction (AMI), including sensitivity analysis for presence of giant cell arteritis (GCA). Using the National Inpatient Sample (January 2004 to September 2015) and International Classification of Diseases, Ninth Revision, all AMI hospitalizations were stratified into main groups: PMR and no-PMR; and subsequently, PMR, PMR with GCA, and GCA and no-PMR. Outcomes were all-cause mortality, major adverse cardiovascular/cerebrovascular events (MACCEs), major bleeding, and ischemic stroke as well as coronary angiography (CA) and percutaneous coronary intervention (PCI). Multivariable logistic regression was used to determine adjusted odds ratios with 95% confidence interval (95% CI). A total of 7,622,043 AMI hospitalizations were identified, including 22,597 patients with PMR (0.3%) and 5,405 patients with GCA (0.1%). Patients with PMR had higher rates of mortality (5.8% vs 5.4%, p = 0.013), MACCEs (10.2% vs 9.2%, p <0.001), and stroke (4.6% vs 3.5%, p <0.001) and lower receipt of CA (48.9% vs 62.6%, p <0.001) and PCI (30.6% vs 41.0%, p <0.001) than the no-PMR group. After multivariable adjustment, patients with PMR had decreased odds of mortality (0.75, 95% CI 0.71 to 0.80), MACCEs (0.78, 95% CI 0.74 to 0.81), bleeding (0.79, 95% CI 0.73 to 0.86), and stroke (0.88, 95% CI 0.83 to 0.93); no difference in use of CA (1.01, 95% CI 0.98 to 1.04) and increased odds of PCI (1.07 95% CI 1.03 to 1.10) compared with the no-PMR group. Similar results were observed for patients with concomitant PMR and GCA, whereas patients with GCA only showed increased odds of bleeding (1.51 95% CI 1.32 to 1.72) and stroke (1.31 95% CI 1.16 to 1.47). In conclusion, patients with AMI with PMR have an increased incidence of crude adverse in-hospital outcomes than those without PMR; however, these differences do not persist after adjusting for age and comorbidities.
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Kozor R, Abiodun A, Kott K, Manisty C. Non-invasive Imaging in Women With Heart Failure - Diagnosis and Insights Into Disease Mechanisms. Curr Heart Fail Rep 2022; 19:114-125. [PMID: 35507121 PMCID: PMC9177491 DOI: 10.1007/s11897-022-00545-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE OF REVIEW To summarise the role of different imaging techniques for diagnosis and investigation of heart failure in women. RECENT FINDINGS Although sex differences in heart failure are well recognised, and the scope of imaging techniques is expanding, there are currently no specific guidelines for imaging of heart failure in women. Diagnosis and stratification of heart failure is generally performed first line using transthoracic echocardiography. Understanding the aetiology of heart failure is central to ongoing management, and with non-ischaemic causes more common in women, a multimodality approach is generally required using advanced imaging techniques including cardiovascular magnetic resonance imaging, nuclear imaging techniques, and cardiac computed tomography. There are specific considerations for imaging in women including radiation risks and challenges during pregnancy, highlighting the clear unmet need for cardiology and imaging societies to provide imaging guidelines specifically for women with heart failure.
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Affiliation(s)
- Rebecca Kozor
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Royal North Shore Hospital, Sydney, Australia
| | - Aderonke Abiodun
- Institute of Cardiovascular Science, University College London, London, UK
| | | | - Charlotte Manisty
- Institute of Cardiovascular Science, University College London, London, UK
- Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London, UK
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Sagheer S, Deka P, Pathak D, Khan U, Zaidi SH, Akhlaq A, Blankenship J, Annis A. Clinical Outcomes of Acute Myocardial Infarction Hospitalizations with Systemic Lupus Erythematosus: An Analysis of Nationwide Readmissions Database. Curr Probl Cardiol 2021; 47:101086. [PMID: 34936910 DOI: 10.1016/j.cpcardiol.2021.101086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 12/15/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hospital readmissions post-acute myocardial infarctions (AMIs) are associated with adverse cardiovascular outcomes and also incur huge healthcare costs. Patients with systemic lupus erythematosus (SLE) are at an increased risk of AMI likely due to multi-factorial mechanisms including higher levels of inflammation and accelerated atherosclerosis. We investigated if patients with SLE are at higher risk of hospital readmissions post-AMI compared to the patients without SLE. Furthermore, we sought to assess if inpatient outcomes of AMI in SLE patients are different than AMI without SLE. METHODS We conducted a retrospective analysis of adult hospital discharges with the principal diagnosis of AMI using the Nationwide Readmissions Database in 2018. We used the International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) to identify comorbid conditions. The primary outcome was all-cause 30-day readmission. Secondary outcomes were cardiac procedures at index hospitalization (percutaneous coronary intervention [PCI] and coronary artery bypass grafting [CABG]), and adverse events at index hospitalization, including inpatient mortality, cardiac arrest, cardiogenic shock, cardiac assist device, coronary artery dissection, acute kidney injury, gastrointestinal bleeding, stroke, post-procedural hemorrhage, sepsis, and hospital costs. Complex samples multivariable logistic regression models were used to determine the association of SLE with outcomes. RESULTS The patients with AMI and SLE had a higher 30-day readmission rate (15.5% vs 12.5%, aOR=1.33, CI 1.12 - 1.57, p=0.001), and inpatient mortality (aOR=1.40 CI 1.1 - 1.79, p=0.006) compared to the AMI without SLE cohort. The rates of acute kidney injury (aOR=1.41 CI 1.21 - 1.64, p<0.0001) and sepsis (aOR= 1.61 CI 1.16 - 2.23, p=0.004) were higher among AMI with SLE group as compared to AMI without SLE group. Within the AMI with SLE cohort, the independent predictors of readmission were diabetes mellitus (aOR=1.38 CI 0.99 - 1.91, p=0.054), peripheral vascular disease (aOR=2.10 CI 1.22 - 3.62, p=0.007), anemia (aOR=1.50 CI 1.07 - 2.11, p=0.019), end-stage renal disease (aOR=1.91 CI 1.10 - 3.31, p=0.021), and congestive heart failure (aOR=1.55 CI 1.12 - 2.16, p=0.009). The length of stay in days during index hospitalization (5.10 vs 4.67) was similar in both cohorts. In the multivariable-adjusted regression model, no statistically significant differences were noted between the AMI with SLE and AMI without SLE cohorts for most inpatient adverse events during the index hospitalization CONCLUSION: Patients with AMI and SLE had higher inpatient mortality during the index hospitalization and higher 30-day hospital readmissions compared to AMI patients without SLE. There were no significant differences in most of the other major inpatient outcomes between the two cohorts.
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Affiliation(s)
- Shazib Sagheer
- Division of Cardiology, University of New Mexico Health Sciences Center, Albuquerque, NM.
| | - Pallav Deka
- College of Nursing, Michigan State University, East Lansing, MI
| | - Dola Pathak
- Department of Statistics and Probability, Michigan State University, East Lansing, MI
| | - Umair Khan
- Division of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM
| | | | - Anum Akhlaq
- Department of Internal Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - James Blankenship
- Division of Cardiology, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Ann Annis
- College of Nursing, Michigan State University, East Lansing, MI
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10
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Gieszczyk-Strózik K, Wybraniec MT, Widuchowska M, Brzezińska-Wcisło L, Kotyla P, Kucharz E, Mizia-Stec K. CHLD score, a new score based on traditional risk factor evaluation and long-term cardiovascular outcomes in patients with systemic sclerosis. Sci Rep 2021; 11:19598. [PMID: 34599271 PMCID: PMC8486848 DOI: 10.1038/s41598-021-99215-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/22/2021] [Indexed: 11/09/2022] Open
Abstract
The aim of the study was to assess the predictors of major adverse cardiovascular events (MACE) in patients with systemic sclerosis (SSc) without pulmonary arterial hypertension. The study comprised 68 patients with SSc who were followed up for the median time of 99 (96; 107) months. The main exclusion criteria involved tricuspid regurgitation maximal velocity > 2.8 m/s and structural heart disease. At baseline the patients underwent clinical assessment of cardiovascular risk factors, 6-min walk test, transthoracic echocardiography and biomarker testing, including growth differentiation factor 15 (GDF-15). The primary composite endpoint was onset of MACE defined as death, myocardial infarction, myocardial revascularization and hospitalization for heart failure. The follow-up consisted of outpatient visits at 1 year intervals and telephone interview every 6 months. The baseline analysis revealed that chronic kidney disease (HR 28.13, 95%CI 4.84–163.38), lung fibrosis on high resolution computed tomography (HR 4.36, 95%CI 1.04–18.26) and GDF-15 concentration (unit HR 1.0006, 95%CI 1.0002–1.0010) were independent predictors of MACE occurrence. CHLD (Chronic kidney disease, Hypertension, hyperLipidaemia, Diabetes mellitus) score was formulated which assigned 1 point for the presence of arterial hypertension, hyperlipidaemia, diabetes mellitus and chronic kidney disease. After inclusion of CHLD score in Cox proportional model, it remained the only independent predictor of MACE onset (unit HR per 1 point 3.46; 95%CI 2.06–5.82, p < 0.0001). Joint assessment of traditional risk factors in the form of CHLD score may serve as a reliable predictor of long-term outcome in patients with SSc without pulmonary arterial hypertension.
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Affiliation(s)
- Klaudia Gieszczyk-Strózik
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 47 Ziołowa St., 40-635, Katowice, Poland.,Upper Silesia Medical Centre, Katowice, Poland
| | - Maciej T Wybraniec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 47 Ziołowa St., 40-635, Katowice, Poland. .,Upper Silesia Medical Centre, Katowice, Poland.
| | - Małgorzata Widuchowska
- Upper Silesia Medical Centre, Katowice, Poland.,Department of Internal Medicine, Rheumatology and Clinical Immunology; School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Ligia Brzezińska-Wcisło
- Department of Dermatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Przemysław Kotyla
- Upper Silesia Medical Centre, Katowice, Poland.,Department of Internal Medicine, Rheumatology and Clinical Immunology; School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Eugeniusz Kucharz
- Upper Silesia Medical Centre, Katowice, Poland.,Department of Internal Medicine, Rheumatology and Clinical Immunology; School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Mizia-Stec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 47 Ziołowa St., 40-635, Katowice, Poland.,Upper Silesia Medical Centre, Katowice, Poland
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