Review of the Association Between Long-Term and Current Systemic Steroid Use With Electromechanical Complications and Inpatient Mortality After ST-Elevation Myocardial Infarction

Background The impact of long-term systemic steroid use on electrical and mechanical complications following ST-segment elevation myocardial infarction (STEMI) has not been extensively studied. Methods In a retrospective cohort study of the National Inpatient Sample (NIS) from 2018 to 2020, adults admitted with STEMI were dichotomized based on the presence of long-term (current) systemic steroid (LTCSS) use. The primary outcome was all-cause mortality. Secondary outcomes included a composite of mechanical complications, electrical, hemodynamic, and thrombotic complications, as well as revascularization complexity, length of stay (LOS), and total charge. Multivariate linear and logistic regressions were used to adjust for confounders. Results Out of 608,210 admissions for STEMI, 5,310 (0.9%) had LTCSS use. There was no significant difference in the odds of all-cause mortality (aOR: 0.89, 95%CI: 0.74-1.08, p-value: 0.245) and the composite of mechanical complications (aOR: 0.74, 95%CI: 0.25-2.30, p-value: 0.599). LTCSS use was associated with lower odds of ventricular tachycardia, atrioventricular blocks, new permanent-pacemaker insertion, cardiogenic shock, the need for mechanical circulatory support, mechanical ventilation, cardioversion, a reduced LOS by 1 day, and a reduced total charge by 34,512 USD (all p-values: <0.05). There were no significant differences in the revascularization strategy (coronary artery bypass graft (CABG) vs. percutaneous coronary interventions (PCI)) or in the incidence of composite thrombotic events. Conclusion LTCSS use among patients admitted with STEMI was associated with lower odds of electrical dysfunction and hemodynamic instability but no difference in the odds of mechanical complications, CABG rate, all-cause mortality, cardiac arrest, or thrombotic complications. Further prospective studies are needed to evaluate these findings further.

Timing of Non-Urgent Transesophageal Echocardiography and The Risk of Embolic Events Among Patients Admitted with Infective Endocarditis. A Review of the National Inpatient Sample

BACKGROUND

In patients hospitalized for infective endocarditis (IE), timing of non-urgent transesophageal echocardiography (TEE) to reduce embolic events (EE) is unclear.

METHOD AND RESULTS

In a retrospective cohort from the 2016 to 2018 combined National Inpatient Sample (NIS), Low-risk adults with IE who underwent non-urgent (>48 hours) TEE were stratified into 3 cohorts based on the timing of the first TEE: early-TEE (3-5 days), intermediate-TEE (5-7 days) and late-TEE (> 7). The primary outcome was a composite of an embolic event. Each day before TEE led to 3% increased odds of composite-embolic-events (P<0.001), 1.21-day extra LOS (P<0.001) and 14,186 USD increased total charge (P<0.001). Early compared to late TEE led to reduced LOS by 10 days (P<0.001) and total cost by 102,273 USD (P<0.001), odds reduction of 27% in embolic strokes, 21% in septic arterial embolization and 50% reduction in preoperative time (P<0.001).

CONCLUSION

Among patients hospitalized for suspected IE, the time to TEE was correlated with increased odds of all EE, prolonged preoperative time for valve surgery, LOS, and total charge. Early TEE compared to late TEE led to the largest reduction in length of stay and total cost.

Abstract P183: Systolic Dysfunction is Associated With Increased Occurrence and Worse Outcomes of Periprocedural Cardiovascular Adverse Events After Transcatheter Aortic Valve Replacement

Background: Transcatheter aortic valve replacement (TAVR) rate continues to ascend nationwide as per the transcatheter valve therapy registry, and this calls for even better strategies to aim for negligible complication rates. Current practice relies on surgically derived risk models. We set out to assess the impact of systolic dysfunction on perioperative cardiovascular adverse events.

Hypothesis: The presence of systolic dysfunction is associated with increased frequency and poorer outcomes of periprocedural cardiovascular adverse events among patients undergoing TAVR.

Method: A retrospective cohort study was designed using data obtained from the 2016 to 2018 combined National Inpatient Sample (NIS) database. The current procedural terminology (CPT) Codes of ICD-10 were used to identify patients admitted for TAVR. They were then dichotomized into two cohorts based on the presence of systolic dysfunction. Primary outcomes were death, length of stay, total charge, composite of all cardiovascular perioperative adverse events and composite of all cardiovascular perioperative adverse events and death. Secondary outcomes were individual cardiovascular perioperative adverse events for all TAVR admissions and subsequently for patients with post-TAVR cardiac dysfunction. Multivariate linear and logistic regressions were used to adjust for confounders.

Results: There was a total of 145,640 admissions for TAVR among whom were 16,980 with systolic dysfunction. Details of outcomes of study are summarized in table 1 below.

Conclusion: Among inpatients who underwent TAVR, systolic dysfunction is associated with higher odds of mortality, composite of all cardiovascular adverse events and composite of death and all cardiovascular adverse events. There was increased odds of periprocedural cardiac dysfunction, particularly with increased cardiogenic shock. There was increased length of stay and total charge.

Abstract P596: Familiar Hypercholesterolemia is Associated With Lower All-Cause Mortality Despite Higher Complexity of Coronary Lesions and Interventions Among Patients Admitted With Acute Myocardial Infarction

Background: Familiar hypercholesterolemia is a genetic disorder affecting lipoprotein metabolism which is strongly associated with early atherosclerosis. Our resolve in this study is to evaluate the severity of coronary lesions ,complexity of acute interventions and clinical outcomes.

Hypothesis: Patients with familiar hypercholesterolemia are relatively younger, have high coronary atheroma burden with less comorbidities, thus likely to have complex atherosclerosis but with paradoxical better prognosis.

Method: A retrospective cohort study with data from the 2016 to 2018 combined National Inpatient Sample (NIS) database was employed. ICD-10 codes were used to sample all admissions for acute myocardial infarction who were then dichotomized based secondary diagnosis of familiar hypercholesterolemia. Procedure codes of ICD-10 were used to identify patients undergoing coronary revascularizations. We determined relative frequencies of various ischemic injury patterns and complexity of revascularization procedures among the two cohorts. Primary clinical outcome of mortality rate, and secondary outcomes including length of stay and total hospital charge were then assessed. Multivariate linear and logistic regressions were used to adjust for confounders.

Results: We identified a total of 4,300,389 adult hospitalizations for acute myocardial infarction including 0.033% with familiar hypercholesterolemia. Patients with familiar hypercholesterolemia were younger (55.8 years vs 58.2 years, adjusted mean difference: -7.87 years, 95%CI: -9.49 years to -6.0 years). Table 1 below shows details of outcomes of our study.

Conclusion: Among patients hospitalized with acute myocardial infarction, comorbid familiar hypercholesterolemia was associated with a 62% reduction in odds of in-hospital all-cause mortality despite a 2.25-fold increased odds of STEMI and higher odds for having multivessel percutaneous. revascularization.

Abstract P184: Systolic Dysfunction is Associated With Increased Occurrence and Worse Outcomes of Periprocedural Cardiovascular Adverse Events After Percutaneous Transluminal Coronary Angioplasty

Background: The percutaneous transluminal coronary angioplasty (PTCA) rate continues to increase nationwide, and better strategies to achieve negligible complication rates are required. Data on risk assessment specific to cardiovascular complications are limited.

Hypothesis: The presence of systolic dysfunction is associated with increased frequency and adverse outcomes of periprocedural cardiovascular complications among patients undergoing percutaneous transluminal coronary angioplasty.

Method: A retrospective cohort study was designed using data obtained from the 2016 to 2018 combined National Inpatient Sample (NIS) database. The current procedural terminology (CPT) Codes of ICD-10 were used to identify patients admitted for percutaneous transluminal coronary angioplasty. They were then dichotomized into two cohorts based on the presence of systolic dysfunction. Primary outcomes were death, length of stay, total charge, composite of all cardiovascular perioperative adverse events and composite of all cardiovascular perioperative adverse events and death. Secondary outcomes were individual cardiovascular perioperative adverse events for all PTCA admissions and subsequently for patients with post-PTCA cardiac dysfunction. Multivariate linear and logistic regressions were used to adjust for confounders.

Results: There was a total of 1,176,340 admissions for percutaneous transluminal angioplasty among whom were 145,330 with systolic dysfunction. Details of study outcomes are summarized in table 1 below.

Conclusion: Among inpatients who underwent PTCA, systolic dysfunction is associated with higher odds of; composite of all periprocedural cardiovascular adverse outcomes, and composite of death and periprocedural adverse outcomes. This is largely driven by increased odds of all-cause mortality and odds of periprocedural cardiac dysfunction, particularly with increased ventricular tachycardias and cardiogenic shock. There was increased length of stay and total charge.

Increased national mortality in acute myocardial infarction hospitalization during the COVID-19 pandemic

This retrospective study describes the effect of the COVID-19 pandemic on epidemiologic trends and highlights disparities in outcomes among acute myocardial infarction (AMI) hospitalizations. The National Inpatient Sample database from 2016 to 2020 was searched for hospitalizations of adult patients with AMI as a principal diagnosis using Clinical Classifications Software Refined codes. The admission rate for each calendar year was obtained as admission per 1000 adults hospitalized. The primary outcome was a comparison of inpatient mortality, and the secondary outcomes were the length of hospital stay and total hospital charge between prepandemic and pandemic years. During the pandemic (2020), the admission rate for AMI was 31.1 admissions per 1000 adults hospitalized compared to 33.4 admissions in 2019 (prepandemic) (P  < 0.001). When compared to the prepandemic admissions, those admitted during the pandemic had a lower mean age (66.5 ± 13.2 vs 66.9 ± 13.4, P  < 0.001), with more women (36.3% vs 37.3%, P  < 0.001). The inpatient mortality during the pandemic was 5.0% compared to 4.5% in 2019 (P  < 0.001). Mortality increased 12.0% in women vs 9.5% in men, 13.2% in Blacks vs 8.9% in Whites, and 6.5% in low-income vs 4.3% in high-income household hospitalizations. In conclusion, our study showed a statistically significant reduction in AMI admission rates during the pandemic and an increase in inpatient mortality. There were significant disparities in the increase in mortality across sociodemographic groups.