Background/Purpose: Several studies in the past have shown significantly increased risks of cardiovascular disease in patients with ANCA associated vasculitis (AAV). This association is thought to be secondary to systemic inflammation as well as glucocorticoid use and their role in premature atherosclerosis. In this study, we aimed to evaluate the outcomes of patients hospitalized for acute myocardial infarction (AMI) in those with and without a history of AAV in a nationally representative sample.

Methods: We used data from the National Inpatient Sample (NIS) for the period of 2016 to-2017 for adult AMI hospitalizations as a primary diagnosis and AAV as a secondary diagnosis using ICD-10 codes. The proportion who met ACR classification criteria cannot be determined with the NIS database. We used STATA.15 for the data analysis and logistic regression was applied to calculate adjusted odds ratios (aOR) for inpatient mortality and length of stay (LOS) in AMI hospitalizations in patients with and without a history of AAV.

Results: We identified a total of 1305889 AMI hospitalizations over a 2-year period of 2016 to 2017 of which 1040 patients had a history of AAV. There was no statistically significant difference in the age between two groups of patients. Compared to the patient without AAV, a higher proportion of patients were female in the AAV group (46% vs 38%; p= 0.01). There was a statistically significant difference in Charlson comorbidity index between two groups of AMI with AAV vs without AAV (72% vs 51%; P< 0.01)

In-hospital mortality after MI in patients with a history of AAV compared with those without AAV was not different (5.3% vs. 4.7%; P= 0.66). In Multivariate logistic regression model after adjusting for age, sex, hospital teaching status, hospital bed size, insurance status, and Charlson comorbidity index, there was no difference in the odds of in-hospital mortality in patients with history of AAV compared with no history of AAV (OR 1.06; 95% CI 0.57-1.97).

Unadjusted mean LOS in AMI patients with a history of AAV was not statistically different from those without AAV (5.02 vs. 4.44; P=0.09). In multivariate Regression model; after adjusting for age, sex, household income, Hospital location, Hospital teaching status, Hospital bed size, and Charlson comorbidity index, mean LOS following MI in patients with AAV vs. no AAV was not different (P=0.73).

Conclusion: Inpatient mortality after AMI as well as LOS were similar in patients with and without AAV in the 2-year period of 2016-2017 despite previously known greater risk of Cardiovascular disease in patients with AAV. These findings may be related to better disease control with Rituximab and reduction in the use of glucocorticoids in these patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/outcomes-of-hospitalizations-for-acute-myocardial-infarction-in-patients-with-anca-associated-vasculitis-from-the-national-inpatient-sample/