Management and outcomes of patients with ST-elevation myocardial infarction and liver disease—Insights from the Nationwide Readmissions Database

Background

The association between cardiovascular disease and advanced liver disease is incompletely understood. To explore this interaction, we compared management, clinical outcomes, readmission rates, and resource utilization in ST-elevation myocardial infarction (STEMI) patients with and without liver disease.

Methods

The Nationwide Readmissions Database (2016–2020) was queried to identify hospitalizations for STEMI. Cohorts were stratified by presence of liver disease. Liver disease was defined as documented diagnosis of liver cirrhosis or liver failure. Multivariable regression model and propensity score matching was used to compare the risk of outcomes.

Results

Among 1,029,608 hospitalizations for STEMI; 45,478 (4.4 %) patients had a history of significant liver disease. Patient with liver disease had higher baseline prevalence of diabetes, chronic kidney disease, anemia, and heart failure. After propensity matching (N = 24,067 in each group), patients with liver disease had higher in-hospital mortality (48.8 % vs 17.3 %, aOR: 6.80 [CI: 6.55–7.06], p < 0.001) and adverse events, including cerebrovascular accidents (6.8 % vs 4.4 %, aOR:1.74 [CI: 1.62–1.86], p < 0.001), cardiac arrest (24.4 % vs 10.3 %, aOR:3.34 [CI: 3.21–3.48], p < 0.001), cardiogenic shock (55.9 % vs 21.1 %, aOR: 6.4 [CI: 6.18–6.64], p < 0.001), mechanical circulatory support requirement (36.2 % vs 14.4 %, aOR: 4.2 [CI: 4.01–4.34], p < 0.001), and major adverse cardiovascular and cerebrovascular events (61.1 % vs 25.3 %, aOR:6.5 [CI: 6.28–6.75], p < 0.001). From 2016 to 2020, in-hospital mortality for STEMI did not change significantly for patients with liver disease (47.4 % to 48.6 % p-trend: 0.826), however percutaneous coronary intervention (PCI) use increased from 43.6 % to 52.2 % (p-trend <0.001).

Conclusion

In STEMI hospitalizations, patients with liver disease have significantly higher mortality, and adverse events as compared with those without liver disease. Despite the increasing use of primary PCI, mortality remains high in STEMI patients with liver disease.