Trends, management and outcomes of acute myocardial infarction in chronic liver disease

Abstract

Aims There are limited data on the management and outcomes of chronic liver disease (CLD) patients presenting with acute myocardial infarction (AMI), particularly according to the subtype of CLD. Methods Using the Nationwide Inpatient Sample (2004‐2015), we examined outcomes of AMI patients stratified by severity and sub‐types of CLD. Multivariable logistic regression was performed to assess the adjusted odds ratios (aOR) of receipt of invasive management and adverse outcomes in CLD groups compared with no‐CLD. Results Of 7 024 723 AMI admissions, 54 283 (0.8%) had a CLD diagnosis. CLD patients were less likely to undergo coronary angiography (CA) and percutaneous coronary intervention (PCI) (aOR 0.62, 95%CI 0.60‐0.63 and 0.59, 95%CI 0.58‐0.60, respectively), and had increased odds of adverse outcomes including major adverse cardiovascular and cerebrovascular events (1.19, 95%CI 1.15‐1.23), mortality (1.30, 95%CI 1.25‐1.34) and major bleeding (1.74, 95%CI 1.67‐1.81). In comparison to the non‐severe CLD sub‐groups, patients with all forms of severe CLD had the lower utilization of CA and PCI (P < .05). Among severe CLD patients, those with alcohol‐related liver disease (ALD) had the lowest utilization of CA and PCI; patients with ALD and other CLD (OCLD) had more adverse outcomes than the viral hepatitis sub‐group (P < .05). Conclusions CLD patients presenting with AMI are less likely to receive invasive management and are associated with worse clinical outcomes. Further differences are observed depending on the type as well as severity of CLD, with the worst management and clinical outcomes observed in those with severe ALD and OCLD.

De Ritis ratio and long‐term major cardiovascular adverse events in patients undergoing elective percutaneous coronary intervention

“…Large PCI studies have shown worse clinical outcomes in patients with CLD compared with patients without liver disease and have identified a number of factors leading to an increased risk of adverse events in patients with CLD after PCI 8–12 . De Ritis ratio is a readily available marker of liver disease 2 .…”

“…Large PCI studies have shown worse clinical outcomes in patients with CLD compared with patients without liver disease and have identified a number of factors leading to an increased risk of adverse events in patients with CLD after PCI. [8][9][10][11][12] De Ritis ratio is a readily available marker of liver disease. 2 An association of De Ritis ratio with an increased risk of mortality has been reported in patients with acute myocardial infarction, 15,16 type 2 diabetes, 27 arterial hypertension, 28 and contrast-induced acute kidney injury after elective PCI.…”

“…CLD increases the odds of major adverse cardiovascular and cerebrovascular events, mortality and major bleeding, contrast-induced acute renal injury, longer hospitalization and increased costs after PCI 8,10,11 and patients with advanced CLD are less likely to undergo PCI due to fears of increased risk of complications. 12 However, most patients with CLD remain asymptomatic up to the advanced stages of the disease and are discovered incidentally during medical encounters for other reasons. 13 De Ritis ratio is a readily available noninvasive marker of liver disease.…”

“…Large studies have shown that between .2% 8 and 11.6% 9 of percutaneous coronary intervention (PCI) are performed in patients with a formal diagnosis of cirrhosis. CLD increases the odds of major adverse cardiovascular and cerebrovascular events, mortality and major bleeding, contrast‐induced acute renal injury, longer hospitalization and increased costs after PCI 8,10,11 and patients with advanced CLD are less likely to undergo PCI due to fears of increased risk of complications 12 . However, most patients with CLD remain asymptomatic up to the advanced stages of the disease and are discovered incidentally during medical encounters for other reasons 13 .…”