Outcomes of Acute Myocardial Infarction in Patients With Hypertrophic Cardiomyopathy.
Am J Med. 2015 Apr 21;
Authors: Gupta T, Harikrishnan P, Kolte D, Khera S, Aronow WS, Mujib M, Palaniswamy C, Sule S, Jain D, Ahmed A, Lanier GM, Cooper HA, Frishman WH, Fonarow GC, Panza JA
Abstract
BACKGROUND: Acute myocardial infarction is a recognized complication in patients with hypertrophic cardiomyopathy. However, limited data are available on outcomes of hypertrophic cardiomyopathy patients with acute myocardial infarction.
METHODS: We analyzed the 2003-2011 Nationwide Inpatient Sample databases to identify all patients aged ≥18 years with a principal diagnosis of acute myocardial infarction. Patients with a concomitant diagnosis of hypertrophic cardiomyopathy were then identified and analyzed as a separate cohort. Multivariate logistic regression was used to compare outcomes in patients with acute myocardial infarction with and without hypertrophic cardiomyopathy.
RESULTS: Of 5,901,827 patients with acute myocardial infarction, 5,688 (0.1%) had a diagnosis of hypertrophic cardiomyopathy. Hypertrophic cardiomyopathy patients were older, more likely to be female, and less likely to have traditional cardiovascular risk factors. Compared to patients without hypertrophic cardiomyopathy, patients with hypertrophic cardiomyopathy were less likely to present with ST-elevation myocardial infarction (STEMI) and more likely to present with non-ST-elevation myocardial infarction (NSTEMI). Hypertrophic cardiomyopathy patients with STEMI or NSTEMI were less likely to receive revascularization. In the overall acute myocardial infarction population, there was no difference in risk-adjusted in-hospital mortality between patients with and without hypertrophic cardiomyopathy (OR 0.96, 95% CI 0.84-1.11, p=0.59). In the STEMI population, patients with hypertrophic cardiomyopathy had lower risk-adjusted in-hospital mortality than those without hypertrophic cardiomyopathy (OR 0.75, 95% CI 0.63-0.91, p=0.003), whereas, in the NSTEMI population, there was no difference in risk-adjusted in-hospital mortality between patients with and without hypertrophic cardiomyopathy (OR 0.97, 95% CI 0.84-1.11, p=0.63).
CONCLUSION: Hypertrophic cardiomyopathy patients represent a small proportion of patients with acute myocardial infarction and are less likely to receive revascularization. Compared to patients without hypertrophic cardiomyopathy, hypertrophic cardiomyopathy patients with STEMI have lower risk-adjusted in-hospital mortality.
PMID: 25910786 [PubMed - as supplied by publisher]