Trends, Management and Outcomes of Acute Myocardial Infarction in Chronic Liver Disease

Andrija Matetic , Tahmeed Contractor , Mohamed O. Mohamed, Rahul Bhardwaj , Ashish Aneja , Phyo K Myint, M Rakoski , Shelley Zieroth, Timir K Paul, Mamas A Mamas* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Aims There is limited data on the management and outcomes of chronic liver disease (CLD) patients presenting with acute myocardial infarction (AMI), particularly according to the subtype of CLD. Methods Using the Nationwide Inpatient Sample (2004‐2015), we examined outcomes of AMI patients stratified by severity and sub‐types of CLD. Multivariable logistic regression was performed to assess the adjusted odds ratios (aOR) of receipt of invasive management and adverse outcomes in CLD groups compared with no‐CLD. Results Out of 7,024,723 AMI admissions, 54,283 (0.8%) had a CLD diagnosis. CLD patients were less likely to undergo coronary angiography (CA) and percutaneous coronary intervention (PCI) (aOR 0.62, 95%CI 0.60‐0.63 and 0.59, 95%CI 0.58‐0.60, respectively), and had increased odds of adverse outcomes including major adverse cardiovascular and cerebrovascular events (1.19, 95%CI 1.15‐1.23), mortality (1.30, 95%CI 1.25‐1.34) and major bleeding (1.74, 95%CI 1.67‐1.81). In comparison to the non‐severe CLD sub‐groups, patients with all forms of severe CLD had the lower utilization of CA and PCI (p<0.05). Amongst severe CLD patients, those with alcohol‐related liver disease (ALD) had the lowest utilization of CA and PCI; patients with ALD and other CLD (OCLD) had more adverse outcomes than the viral hepatitis sub‐group (p<0.05). Conclusions CLD patients presenting with AMI are less likely to receive invasive management and are associated with worse clinical outcomes. Further differences are observed depending on the type as well as severity of CLD, with the worst management and clinical outcomes observed in those with severe ALD and OCLD.
Original languageEnglish
Article numbere13841
JournalInternational Journal of Clinical Practice
Early online date21 Nov 2020
DOIs
Publication statusE-pub ahead of print - 21 Nov 2020

Keywords

  • acute myocardial infarction
  • chronic liver disease
  • in-hospital outcomes

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