Published Online
on October 8, 2007

A more recent version of this article appeared on October 23, 2007

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Submitted on June 15, 2007
Accepted on August 28, 2007

Acute Noncardiac Conditions and In-Hospital Mortality in Patients With Acute Myocardial Infarction

Judith H. Lichtman PhD, MPH, John A. Spertus MD, MPH, Kimberly J. Reid MS, Martha J. Radford MD, John S. Rumsfeld MD, PhD, Norrina B. Allen MPH, Frederick A. Masoudi MD, MSPH, William S. Weintraub MD, and Harlan M. Krumholz MD, SM^*

From the Section of Chronic Disease Epidemiology, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn (J.H.L., N.B.A.); Mid America Heart Institute of St Luke’s Hospital, Kansas City, Mo (J.A.S., K.J.R.); University of Missouri, Kansas City (J.A.S.); Division of Cardiology, Department of Medicine, New York University Medical Center, New York (M.J.R.); Denver Veterans Affairs Medical Center, Denver, Colo (J.S.R.); Department of Medicine, Denver Health Medical Center, and the Department of Medicine and Colorado Health Outcomes Program, University of Colorado at Denver and Health Sciences Center, Denver (F.A.M.); Christiana Care Health System, Newark, Del, and the Department of Medicine, Jefferson University, Philadelphia, Pa (W.S.W.); and Section of Cardiovascular Medicine and the Robert Wood Johnson Clinical Scholars Program, Department of Medicine; Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine; and the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn (H.M.K.).

^* To whom correspondence should be addressed. E-mail: harlan.krumholz{at}yale.edu.

Background—Acute myocardial infarction may be accompanied by acute, severe, concomitant, noncardiac conditions, but their prevalence and prognostic importance is not well defined. We sought to evaluate the prevalence of acute, severe, noncardiac conditions present at the time of hospital admission with acute myocardial infarction and to assess the association of these conditions with in-hospital mortality.

Methods and Results—A total of 3907 patients admitted with an acute myocardial infarction were prospectively enrolled in 19 US centers between January 2003 and June 2004. Acute noncardiac conditions present at admission with imminent threat to life were identified from medical record review within 24 hours of admission. Using multivariable analyses, we evaluated the relationship between these conditions and in-hospital mortality. We documented a concomitant acute, severe, noncardiac condition in 6.8% (n=267) of the study sample. The most common concomitant conditions were severe pneumonia (potentially requiring intubation; 18.4%), severe gastrointestinal bleeding/anemia (15.7%), stroke (9.7%), and sepsis (9.4%). These patients were less likely to be ideal for or to receive evidence-based therapies at the time of admission. The in-hospital mortality was 21.3% (57 of 267) for patients with concomitant conditions versus 2.7% (100 of 3640) for those without these conditions. The presence of an acute noncardiac condition was associated with an increased risk of in-hospital mortality after adjustment for demographic and clinical characteristics and disease severity (odds ratio, 5.0; 95% confidence interval, 3.3 to 7.7).

Conclusions—Concomitant, acute, noncardiac conditions are common and associated with a marked increase in the risk of in-hospital mortality.

Key words: comorbidity • mortality • myocardial infarction • prognosis

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