Abstract 15556: Treatment Strategies and Outcomes in Patients With Chronic Hepatitis C Presenting With Acute Myocardial Infarction
Background: Chronic hepatitis C (HCV) is a pro-inflammatory state associated with insulin resistance and coronary atherosclerosis. Patients with HCV may have underlying thrombocytopenia and coagulopathy, which can influence treatment choice and outcomes when these patients present with acute myocardial infarction (AMI).
Objectives: To compare treatment strategies and outcomes among patients with and without HCV presenting with AMI.
Methods: We used the 2003-2010 Nationwide Inpatient Sample databases to identify all patients aged ≥18 years with AMI. Secondary diagnosis of HCV was confirmed with ICD-9-CM code 070.54. Logistic regression was used to compare treatment choice and outcomes between AMI patients with and without HCV.
Results: From 2003-2010, among 4,606,879 patients with AMI, 11,613 (0.3%) had HCV. Patients with HCV were more likely to be younger, male, African-American, and had a higher prevalence of smoking, chronic kidney disease, thrombocytopenia and coagulopathy. Patients with HCV were more likely to receive medical therapy alone (OR1.36, 95% CI 1.30-1.43) and less likely to receive thrombolysis (OR 0.76, 95% CI 0.64-0.91), percutaneous coronary intervention (OR 0.90, 95% CI 0.85-0.94) or coronary artery bypass grafting (CABG) (OR 0.73, 95% CI 0.67-0.78), as compared to those without HCV. Overall risk-adjusted in-hospital mortality was similar in patients with and without HCV. However, when stratified according to treatment received, in-hospital mortality in patients with HCV was lower in those receiving percutaneous coronary intervention (OR 0.49, 95% CI 0.37-0.66), but higher in those undergoing CABG (OR1.47, 95% CI 1.05-2.07). Patients with HCV had less acute ischemic stroke (OR 0.78, 95% CI 0.66-0.93), more intracranial hemorrhage (OR 1.47, 95% CI 1.06-2.03) and gastrointestinal bleeding (OR 1.28, 95% 1.15-1.42), and longer average length of stay (6.3±6.2 vs. 5.7±6.2 days).
Conclusions: HCV patients presenting with AMI are more likely to be medically managed. Compared to patients without HCV, HCV patients with AMI have similar in-hospital mortality, less acute ischemic stroke, more intracranial hemorrhage and gastrointestinal bleeding, and longer length of stay.
- © 2013 by American Heart Association, Inc.