Abstract 18808: Higher Short Term Mortality in Sickle Cell Patients Presenting With ST Elevation Myocardial Infarction

Abstract

Introduction: Sickle cell disease (SCD) has been shown in multiple studies worldwide to be associated with considerable morbidity and mortality, including a higher risk for acute myocardial infarction (AMI). However, the effect of SCD on outcome in patients with myocardial infarction remains unclear. We sought to investigate the in-hospital mortality in patients with SCD presenting with acute ST elevation myocardial infarction (STEMI) compared to the general population. Hypothesis: Short term mortality in patients with SCD presenting with STEMI is higher when compared to the general population. Methods: The National Inpatient Sample (NIS), part of the Healthcare Cost and Utilization Project (HCUP), is the largest publicly available inpatient database designed to provide information on characteristics and outcomes of patients discharged from US hospitals. Using the NIS database, we identified 879,108 adult patients with a primary diagnosis of STEMI in the period between 1998 and 2012. Among this patient population, 52 patients also had a diagnosis of SCD. Results: Compared to the general population, patients with SCD were significantly younger (55 years vs. 66 years, p<0.001), were more likely to be female (60% vs. 37%, p=0.001), and had a lower prevalence of hypertension (35% vs. 47%, p=0.06) and dyslipidemia (2% vs. 13%, p=0.02). They were less likely to undergo revascularization procedures compared to the general population (38% vs. 53%, p=0.04). The in-hospital mortality for patients with STEMI and SCD was 19.2% compared to 10.0% in patients without SCD (p=0.03). After adjusting for pertinent covariates using logistic regression analysis, SCD remained an independent predictor of higher in-hospital mortality (p=0.02, OR 2.4; 95% CI 1.1-5.1). Conclusions: Sickle cell patients have a higher in-hospital mortality compared to the general population when presenting with STEMI.