Key result
Concomitant aortic stenosis in acute myocardial infarction admissions was associated with significantly higher in-hospital mortality (9.2% vs 6.0%; adjusted OR 1.12) and lower use of guideline-directed therapies.
Why the study?
To evaluate the prevalence, management, and outcomes of concomitant aortic stenosis in admissions with acute myocardial infarction.
Does concomitant aortic stenosis worsen in-hospital mortality and alter management in adult patients admitted with acute myocardial infarction?
Observational (n=11,622,528)
Yes
Does concomitant aortic stenosis worsen in-hospital mortality and alter management in adult patients admitted with acute myocardial infarction?
Odds Ratio: 1.12 (95% CI 1.1–1.13)
Absolute Event Rate: 9.2% vs 6%
p-value: p=<0.001
Concomitant aortic stenosis in acute myocardial infarction is associated with lower use of guideline-directed invasive therapies and higher in-hospital mortality.
Alerts clinicians to higher mortality and undertreatment risk in AMI with AS; leaves open whether targeted strategies improve outcomes.
To evaluate the prevalence, management and outcomes of concomitant aortic stenosis (AS) in admissions with acute myocardial infarction (AMI). We used the HCUP-NIS database (2000–2017) to identify adult AMI admissions with concomitant AS. Outcomes of interest included prevalence of AS, in-hospital mortality, use of cardiac procedures, hospitalization costs, length of stay, and discharge disposition. Among a total of 11,622,528 AMI admissions, 513,688 (4.4 %) were identified with concomitant AS. Adjusted temporal trends revealed an increase in STEMI and NSTEMI hospitalizations with concomitant AS. Compared to admissions without AS, those with AS were on average older, of female sex, had higher comorbidity, higher rates of NSTEMI (78.9 % vs 62.1 %), acute non-cardiac organ failure, and cardiogenic shock. Concomitant AS was associated with significantly lower use of coronary angiography (45.5 % vs 64.4 %), percutaneous coronary intervention (20.1 % vs 42.5 %), coronary atherectomy (1.7 % vs. 2.8 %) and mechanical circulatory support (3.5 % vs 4.8 %) (all p < 0.001). Admissions with AS had higher rates of coronary artery bypass surgery and surgical aortic valve replacement (5.9 % vs 0.1 %) compared to those without AS. Admissions with AMI and AS had higher in-hospital mortality (9.2 % vs. 6.0 %; adjusted OR 1.12 [95 % CI 1.10–1.13]; p < 0.001). Concomitant AS was associated with longer hospital stay, more frequent palliative care consultations and less frequent discharges to home. In this 18-year study, an increase in prevalence of AS in AMI hospitalization was noted. Concomitant AS was associated with lower use of guideline-directed therapies and worse clinical outcomes among AMI admissions.
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Patlolla et al. (2022) conducted an observational in Acute myocardial infarction (n=11,622,528). Concomitant aortic stenosis vs. No aortic stenosis was evaluated on In-hospital mortality (adjusted OR 1.12, 95% CI 1.10-1.13, p=<0.001). Concomitant aortic stenosis in acute myocardial infarction admissions was associated with significantly higher in-hospital mortality (9.2% vs 6.0%; adjusted OR 1.12) and lower use of guideline-directed therapies.
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