Background/Purpose: , 

Systemic Sclerosis (SSc) is associated with an increased risk of cardiovascular diseases, including acute myocardial infarction (AMI). However, whether SSc influences treatment choice and in-hospital outcomes in patients with AMI remains unknown.

Methods: , 

We used the 2002-2010 Nationwide Inpatient Sample databases to identify all patients aged ≥18 years with the principal diagnosis of AMI using International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) code 410.xx. Secondary diagnosis of SSc was confirmed with ICD-9-CM code 710.1. Patients with rheumatoid arthritis (714.0-714.2), systemic lupus erythematosus (710.0), dermatomyositis (710.3) and polymyositis (710.4) were excluded. Multivariable logistic regression was used to compare treatment choice and outcomes between AMI patients with and without SSc.

Results:

From 2002-2010, among 5,966,599 patients with AMI, 3,890 (0.07%) had SSc. Patients with SSc were more likely to be younger, women, white and had a lower prevalence of smoking, dyslipidemia, obesity, hypertension, diabetes, known coronary artery diseases, carotid artery diseases, and a higher prevalence of congestive heart failure, peripheral vascular disease, chronic kidney disease, pulmonary circulation disorders, atrial fibrillation, atrioventricular block, deficiency anemia, chronic blood loss anemia, hypothyroidism and coagulopathy. SSc patients were more likely to receive medical therapy alone (OR 1.20, 95% CI 1.10-1.32, p<0.001) and thrombolysis (OR 1.47, 95% CI 1.12-1.92, p=0.005), and less likely to receive coronary artery bypass grafting (CABG) (OR 0.55, 95% CI 0.45-0.68, p<0.001), as compared to those without SSc. Utilization of percutaneous coronary intervention was similar in AMI patients with and without SSc (OR 0.97, 95% CI 0.88-1.06, p=0.486). Overall risk-adjusted in-hospital mortality was higher in patients with SSc (OR 1.60, 95% CI 1.40-1.84, p<0.001), as compared to those without SSc. Patients with SSc had less cardiogenic shock (OR 0.50, 95% CI 0.39-0.64, p<0.001), more gastrointestinal bleeding (OR 1.65 95% 1.38-1.97, p<0.001), and longer average length of stay (5.9±7.1 versus 5.1±6.1 days, p<0.001). Incidence of acute stroke was similar in AMI patients with and without SSc (OR 0.85, 95% CI 0.61-1.17, p=0.321).

Conclusion:

 In patients with AMI, SSc is associated with an increased use of medical therapy alone and thrombolysis , and lesser use of CABG. Compared to  patients without SSc , SSc patients with AMI have higher in-hospital mortality, more gastrointestinal bleeding, less cardiogenic shock and longer length of stay.

---

« Back to 2013 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/treatment-strategies-and-outcomes-in-patients-with-systemic-sclerosis-and-acute-myocardial-infarction/