A-1 | Pattern of Ischemic Injury and Revascularization Outcomes in Acute Coronary Syndrome Patients With Co-Morbid Decubitus Ulcers: A Retrospective Cohort Study

Approximately 5 % of hospitalized patients have comorbid decubitus ulcers. Being a persistent inflammatory state akin to elevated CRP, we postulate that patients with decubitus ulcers may have more severe atherosclerosis and possibly worse revascularization outcomes in acute coronary syndrome. Data were abstracted from National Inpatient Sample (NIS) 2016-18 database to identify ACS hospitalizations with and without decubitus ulcers utilizing ICD-10 codes. Multivariate linear and logistic regression were used to adjust for confounders. Primary and secondary outcomes are shown in the forest plot below. There were over 71,473,874 discharges in the 2016-18 NIS database. Out of 1,945,054 ACS admissions, 18,055 (0.93%) had a decubitus ulcer. ACS hospitalizations with decubitus ulcer compared to without decubitus ulcer had higher inpatient mortality (AOR 1.82, CI 1.63-2.02, p<0.001), lower odds of STEMI (AOR 0.75, CI 0.68-0.82, p<0.001) and higher odds of NSTEMI (AOR 1.35, CI1.23-1.49). ACS-decubitus ulcer patients were less likely to get coronary intervention (AOR 0.40, CI 0.37-0.43, p<0.001), but had higher composite of death and hemodynamic dysfunction(AOR 1.58, CI 1.31-1.89, p< 0.001) if they underwent revascularization. Patients with ACS-decubitus ulcer were more likely to have cardiac arrest (AOR 1.55, CI 1.32-1.82, p< 0.001) and need IABP (AOR 1.33, CI 1.15-1.55, p <0.001). Comorbid decubitus ulcers double the odds of mortality in ACS patients. Risk stratification strategies should be implemented to ensure more intensive care for the high risk ACS-decubitus ulcer cohort.