Introduction:
In infective endocarditis (IE), embolization to the coronary arteries is an uncommon phenomenon but can contribute to transmural infarction presenting as ST elevation myocardial infarction (STEMI). Due to limited date, we intend to evaluate the clinical outcomes in hospitalized patients with STEMI with and without underlying IE.
Hypothesis:
Morbidity and morbidity exponentiates in STEMI with comorbid IE when compared to without IE.
Methods:
Patients with primary diagnosis of STEMI with and without IE were identified by querying the Healthcare Cost and Utilization (HCUP) database, specifically, National Inpatient Sample for year 2013 and 2014 based on ICD9 codes
Results:
During 2013 and 2014, a total of 117, 386 patients were admitted with the principle diagnosis of STEMI, out of whom 305 had comorbid IE. There was an increased in-hospital mortality (27.5% vs 10.8%, increased length of stay (14 vs 5 days), acute kidney injury (44.9% vs 18.7%), stroke (23.6% vs 3%), aortic valve replacement (9.5% vs 0.3%), mitral valve replacement (0.2%-5.2%), sepsis (50% vs 6%) and acute respiratory failure (36.7% vs 16.7%) in patients with STEMI with IE when compared to patients with STEMI and without comorbid IE. STEMI without IE had higher number of angiographies (58.7% vs 25.9%) and percutaneous coronary interventions (50.7% vs 14.4%) during their hospital course when compared to STEMI with IE.
Conclusions:
We conclude that hospitalized STEMI patients with concomitant diagnosis of IE are at higher risk of in-hospital mortality, increased LOS, AKI, stroke, valve replacements, and acute respiratory failure. Clinical trials that compare optimal interventions in these patients would be needed in future.
In patients with infective endocarditis (IE), ST-elevation myocardial infarction (STEMI) is an uncommon phenomenon. Due to limited data, we intend to evaluate the clinical outcomes in hospitalized patients with STEMI with and without underlying IE. Mortality and morbidity are exponentially worse in STEMI with concomitant IE when compared with without IE. Patients with primary diagnosis of STEMI with and without IE were identified by querying the Healthcare Cost and Utilization Project database of the National Inpatient Sample for the years 2013 and 2014 based on International Classification of Diseases, Ninth Revision codes. During 2013 and 2014, a total of 117,386 patients were admitted with the principle diagnosis of STEMI, out of whom 305 had comorbid IE. There was a significantly increased in-hospital mortality (27.5% vs 10.8%), length of stay (LOS) (14 days vs 5 days), acute kidney injury (AKI; 44.9% vs 18.7%), stroke (23.6% vs 3%), aortic valve replacement (9.5% vs 0.3%), mitral valve replacement (0.2%–5.2%), sepsis (50% vs 6%) and acute respiratory failure (36.7% vs 16.7%) in patients with STEMI with IE when compared with patients with STEMI and without comorbid IE. STEMI without IE had a higher number of angiographies (58.7% vs 25.9%) and percutaneous coronary interventions (50.7% vs 14.4%) during the hospital course when compared with STEMI with IE. In conclusions, hospitalized patients with STEMI with a concurrent diagnosis of IE are at higher risk of in-hospital mortality, increased LOS, AKI, stroke, valve replacements, and acute respiratory failure.
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