Impact of lymphoma on clinical outcomes during hospitalization for acute myocardial infarction: a retrospective cohort study from the National Inpatient Sample Database (2016–2021)

Background: Lymphoma increases cardiovascular risk, but its effects on ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) management and outcomes remain unclear. This study compared in-hospital outcomes and treatment strategies between acute myocardial infarction patients with and without lymphoma. Methods: We analyzed the National Inpatient Sample (2016–2021) to identify STEMI and NSTEMI hospitalizations with and without lymphoma using International Classification of Diseases, 10 th Revision, Clinical Modification codes. The primary outcome was in-hospital mortality; secondary outcomes included revascularization coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) and major adverse events. Propensity score matching and multivariable logistic regression were used to adjust for confounding. Results: Among 739 846 hospitalized AMI patients, 4239 (0.57%) had lymphoma. After matching, lymphoma was associated with a significantly higher in-hospital mortality in STEMI patients 15.8 vs. 7.5%, adjusted odds ratio (OR): 2.0, 95% confidence interval (CI): 1.2–1.8, P < 0.001 and a nonsignificant increase in-hospital mortality in NSTEMI patients (5.4 vs. 3.3%; adjusted OR: 1.3, 95% CI: 1.0–1.6, P = 0.080). Lymphoma patients underwent fewer revascularization procedures: CABG rates were lower in both STEMI (3.0 vs. 4.9%, OR: 0.6, P = 0.038) and NSTEMI (6.6 vs. 10.2%, OR: 0.7, P < 0.001) groups, and PCI rates were lower in the STEMI group (53.7 vs. 70.1%, OR: 3.14, P < 0.001). Cardiac arrest was more frequent in STEMI patients with lymphoma (14.3 vs. 6.0%, OR: 2.3, P < 0.001), while bleeding events (gastrointestinal bleeding, hematuria) were more common in NSTEMI patients with lymphoma. Conclusion: AMI patients with lymphoma had higher in-hospital mortality and received fewer guideline-directed revascularizations, revealing a critical care gap. Tailored, multidisciplinary management strategies are needed to improve outcomes in this high-risk population.