A-2 | The impact of Adrenal Insufficiency on outcomes percutaneous coronary intervention in patients with ST elevation myocardial infarction

Literature suggests that adrenal insufficiency could be associated with poor hospital outcomes in patients with ST elevation myocardial infarction (STEMI) and cardiogenic shock. Despite this, there remains a scarcity of data on outcomes of mortality, morbidity, and percutaneous coronary intervention (PCI) in patients admitted with STEMI as a function of adrenal insufficiency. This study was conducted to evaluate whether adrenal insufficiency is associated with poorer hospitalization outcomes in patients with STEMI. We queried the 2016-2019 National Inpatient Sample (NIS) database and identified ST elevation myocardial infarction (STEMI) as the primary diagnosis, with a co-diagnosis of adrenal insufficiency (AI). The primary outcome was the likelihood of PCI while the secondary outcomes included hospital mortality, the likelihood of pressors and/or mechanical ventilatory support, incidence of acute kidney injury (AKI) and the likelihood of temporary circulatory support use (tMCS). Multivariate linear and logistic regression models were used to adjust for demographics, Charleston comorbidity index, and hospital factors. Of all those admitted with a primary diagnosis of STEMI (N=690,430), 0.2% had a secondary diagnosis of adrenal insufficiency. Similarly, of those admitted for a diagnosis of STEMI, 69% were males, 73% were white, and 46% were Medicare patients. Patients with AI were less likely to receive PCI for a diagnosis of STEMI (80% vs. 66% and p<0.01). Inpatient mortality was higher (7.8% vs. 16%, adjusted OR 1.9, p<0.01) and as was the incidence of AKI (16% vs 41%, adjusted OR 3.3, p<0.01). Additionally, patients with AI were more likely to require pressors and/or mechanical ventilatory support (12% vs 31% and p<0.01) and tMCS (10% vs 22%, with p<0.01) during their hospitalization course compared to our control. Patients with adrenal insufficiency admitted for STEMI were less likely to receive PCI, despite being a sicker cohort with a higher inpatient mortality, a higher likelihood of pressor and/or mechanical ventilator support, higher need for tMCS and higher incidence for AKI.