Ahmed N Mahmoud1, Siva Sagar Taduru2, Amgad Mentias3, Dhruv Mahtta4, Amr F Barakat5, Marwan Saad6, Akram Y Elgendy7, Mohammad K Mojadidi7, Mohamed Omer2, Ahmed Abuzaid8, Nayan Agarwal7, Islam Y Elgendy7, R David Anderson7, Jacqueline Saw9. 1. Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida. Electronic address: Ahmed.Mahmoud@medicine.ufl.edu. 2. Department of Medicine, University of Missouri Kansas City, Kansas City, Missouri. 3. Division of Cardiovascular Medicine, University of Iowa, Iowa City, Iowa. 4. Department of Medicine, University of Florida, Gainesville, Florida. 5. UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania. 6. Department of Medicine, Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas. 7. Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida. 8. Department of Cardiovascular Medicine/Heart and Vascular Institute, Sidney Kimmel Medical College at Thomas Jefferson University-Christiana Care Health System, Newark, Delaware. 9. Division of Cardiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada.
Abstract
OBJECTIVES: The authors sought to determine the clinical characteristics and in-hospital survival of women presenting with acute myocardial infarction (AMI) and spontaneous coronary artery dissection (SCAD). BACKGROUND: The clinical presentation and in-hospital survival of women with AMI and SCAD remains unclear. METHODS: The National Inpatient Sample (2009 to 2014) was queried for all women with a primary diagnosis of AMI and concomitant SCAD. Iatrogenic coronary dissection was excluded. The main outcome was in-hospital mortality. Propensity score matching and multivariable logistic regression analyses were performed. RESULTS: Among 752,352 eligible women with AMI, 7,347 had a SCAD diagnosis. Women with SCAD were younger (61.7 vs. 67.1 years of age) with less comorbidity. SCAD was associated with higher incidence of in-hospital mortality (6.8% vs. 3.4%). In SCAD patients, a decrease in in-hospital mortality was evident with time (11.4% in 2009 vs. 5.0% in 2014) and concurred with less percutaneous coronary intervention (PCI) (82.5% vs. 69.1%). Propensity score yielded 7,332 SCAD and 14,352 patients without SCAD. The odds ratio (OR) of in-hospital mortality remained higher with SCAD after propensity matching (OR: 1.87, 95% confidence interval [CI]: 1.65 to 2.11) and on multivariable regression analyses (OR: 2.41, 95% CI: 2.07 to 2.80). PCI was associated with higher mortality in SCAD patients presenting with non-ST-segment elevation myocardial infarction (OR: 2.01; 95% CI: 1.00 to 4.47), but not with STEMI (OR: 0.62; 95% CI: 0.41 to 0.96). CONCLUSIONS: Women presenting with AMI and SCAD appear to be at higher risk of in-hospital mortality. Lower rates of PCI were associated with improved survival, with evidence of worse outcomes when PCI was performed for SCAD in the setting of non with ST-segment elevation myocardial infarction.
OBJECTIVES: The authors sought to determine the clinical characteristics and in-hospital survival of women presenting with acute myocardial infarction (AMI) and spontaneous coronary artery dissection (SCAD). BACKGROUND: The clinical presentation and in-hospital survival of women with AMI and SCAD remains unclear. METHODS: The National Inpatient Sample (2009 to 2014) was queried for all women with a primary diagnosis of AMI and concomitant SCAD. Iatrogenic coronary dissection was excluded. The main outcome was in-hospital mortality. Propensity score matching and multivariable logistic regression analyses were performed. RESULTS: Among 752,352 eligible women with AMI, 7,347 had a SCAD diagnosis. Women with SCAD were younger (61.7 vs. 67.1 years of age) with less comorbidity. SCAD was associated with higher incidence of in-hospital mortality (6.8% vs. 3.4%). In SCAD patients, a decrease in in-hospital mortality was evident with time (11.4% in 2009 vs. 5.0% in 2014) and concurred with less percutaneous coronary intervention (PCI) (82.5% vs. 69.1%). Propensity score yielded 7,332 SCAD and 14,352 patients without SCAD. The odds ratio (OR) of in-hospital mortality remained higher with SCAD after propensity matching (OR: 1.87, 95% confidence interval [CI]: 1.65 to 2.11) and on multivariable regression analyses (OR: 2.41, 95% CI: 2.07 to 2.80). PCI was associated with higher mortality in SCAD patients presenting with non-ST-segment elevation myocardial infarction (OR: 2.01; 95% CI: 1.00 to 4.47), but not with STEMI (OR: 0.62; 95% CI: 0.41 to 0.96). CONCLUSIONS:Women presenting with AMI and SCAD appear to be at higher risk of in-hospital mortality. Lower rates of PCI were associated with improved survival, with evidence of worse outcomes when PCI was performed for SCAD in the setting of non with ST-segment elevation myocardial infarction.
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