Abstract 16951: Incidence, Predictors and Outcomes of Acute Myocardial Infarction in Patients With Sickle Cell Disease: A United States Population-Based Study
Background: Acute myocardial infarction (AMI) in patients with sickle cell disease (SCD) has been described in case reports and case series. However, the exact magnitude of this problem, its risk factors, and its influence on mortality in hospitalized patients with SCD is unknown.
Objectives: To determine the incidence, predictors and outcomes of AMI in hospitalized patients with SCD.
Methods: We queried the 2002-2010 Nationwide Inpatient Sample databases to identify all patients aged ≥18 years with SCD. Incident AMI was identified using ICD-9-CM codes 410.xx. Logistic regression was used to determine independent predictors of AMI in patients with SCD.
Results: Of 773,734 patients aged ≥18 years with SCD, 2,059 (0.3%) had AMI (mean age 47.5 years, 53.2% women, 88.5% African-American). Compared to SCD patients without AMI, those with AMI were older, men, white, and had a higher prevalence of cardiovascular co-morbidities. Using logistic regression, age ≥30 (OR 1.47, 95% CI 1.22-1.77), male gender (OR 1.19, 95% CI 1.07-1.33), white race (OR 1.46, 95% CI 1.16-1.84), dyslipidemia (OR 1.51, 95% CI 1.23-1.85), hypertension (OR 1.18, 95% CI 1.04-1.34), known coronary artery disease (OR 5.00, 95% CI 4.25-5.89), congestive heart failure (OR 2.45, 95% CI 2.15-2.80), alcohol abuse (OR 1.89, 95% CI 1.44-2.48), deficiency anemia (OR 1.21, 95% CI 1.02-1.43), coagulopathy (OR 4.17, 95% CI 3.61-4.82), fluid/electrolyte disorders (OR 2.26, 95% CI 2.03-2.53), pulmonary circulation disorders (OR 1.32, 95% CI 1.09-1.60), weight loss (OR 1.56, 95% CI 1.19-2.04) and sickle cell-thalassemia (OR 1.35, 95% CI 1.07-1.70) were identified as independent predictors of AMI in patients with SCD. Sickle cell crisis was inversely associated with AMI (OR 0.73, 95% CI 0.64-0.82). In SCD patients with AMI, in-hospital mortality was 20.6% and mean length of stay 8.6 days.
Conclusion: In this large, nationwide database, AMI occurred in 0.3% of hospitalized SCD patients. In addition to traditional risk factors of AMI, deficiency anemia, coagulopathy, fluid/electrolyte disorders, weight loss, pulmonary circulation disorders and sickle cell-thalassemia were identified as important predictors of AMI in SCD patients. Interestingly, sickle cell crisis was inversely associated with AMI.
- © 2013 by American Heart Association, Inc.