Date: Monday, November 6, 2017
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Systemic sclerosis (SSc) is a systemic autoimmune disorder characterized by microvascular changes, excessive fibrous tissue deposition and systemic inflammation. Previous studies showed that systemic sclerosis is an independent risk factor for coronary artery disease and involved not only accelerated epicardial atherosclerosis, but also small vessel disease and vasospasm. The aim of this study is to analyze the temporal trend of acute coronary syndrome (ACS) in hospitalized patients with SSc, mortality and other outcomes from 2005 to 2014. We also compared the in-hospital mortality in ACS hospitalizations in patients with and without SSc.
We conducted a retrospective study using data from National Inpatient Sample (NIS) from 2005 to 2014. Diagnoses were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Patients with a diagnosis of ACS (ICD 9 code 410 excluding 410.x2 and 411.1) and SSc (ICD 9 code 710.1) were included. Patients younger than 18 years old were excluded. Primary outcome was the temporal trend of the ratio of ACS hospitalizations compared to all-cause hospitalizations from 2005 to 2014. Secondary outcome was the temporal trend of age-adjusted in-hospital mortality, length of stay and total hospital charges over the study period of time. We also compared the age-adjusted in-hospital mortality in ACS hospitalizations in patients with and without SSc. Logistic regression was used for statistical analysis of hospitalization ratio and age-adjusted in-hospital mortality and linear regression was used for length of stay and total hospital charges.
A total of 66,392 ACS hospitalizations in adult patients with SSc from 2005 to 2014 were identified. Compared with all-cause hospitalizations, the ratio of ACS hospitalizations were stable (3.57% in 2005 and 3.58% in 2014, p = 0.822) among patients with SSc, while the ratio was decreased (3.76% in 2005 and 3.19% in 2014, p < 0.001) among general adult populations. Age-adjusted in-hospital mortality was significantly higher in those with SSc compared to non-SSc (OR 2.25, 95% CI 1.95 – 2.60, p < 0.001) and did not change significantly (16.99% in 2005 and 16.19% in 2014, p = 0.412) from 2005 to 2014. Length of stay decreased significantly (7.42 days in 2005 and 6.13 days in 2014, p = 0.044) and total hospital charges increased significantly (55,280 in 2005 and 76,486 in 2014, p = 0.001) over the 10 year period.
Our study shows that ACS hospitalizations in SSc patients have more than doubled risk of death compared to those without SSc and both the ratio of ACS hospitalizations and age-adjusted in-hospital mortality failed to decrease over time. Our study highlights that there is a critical gap in preventing and treating ACS in SSc populations.
To cite this abstract in AMA style:Luo Y, Xu J, Wen Y, Jiang C, Fang S, Kagalwalla M, Wei X, Yue B. A 10-Year National Trend in Acute Coronary Syndrome Among Hospitalized Patients with Systemic Sclerosis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/a-10-year-national-trend-in-acute-coronary-syndrome-among-hospitalized-patients-with-systemic-sclerosis/. Accessed July 6, 2020.
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