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In-hospital outcomes worse for heart transplant recipients with acute MI
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Heart transplant recipients with acute MI had longer length of hospital stay, more in-hospital morbidity, a lower likelihood of receiving invasive treatments and higher 30-day readmission rates than those with acute MI and no heart transplant, according to a study published in The American Journal of Cardiology.
“Compared to general [acute] MI population, post-[heart transplantation] patients with [acute] MI was associated with higher baseline comorbidities, worse post-[acute] MI in-hospital outcomes and less use of invasive therapy,” Tariq Enezate, MD, practicing internist at the Truman Medical Center at the University of Missouri, and colleagues wrote. “Further studies are needed to confirm the results of this study and to address unanswered questions such as whether early treatment would decrease [acute] MI complications and improve outcomes and whether immunosuppressive therapy affects the incidence and complication rates of [acute] MI in [heart transplantation].”
To examine the differences in the outcomes of acute MI in heart transplant recipients vs. the general population (no heart transplant), researchers identified 259,794 participants from the 2014 National Readmissions Database who had been discharged with a principal diagnosis of acute MI, of whom 789 had a history of heart transplant. Heart transplant recipients tended to have a higher percentage of hypertension, hyperlipidemia, history of HF, chronic kidney disease, atrial fibrillation, long-term anticoagulation and number of chronic conditions than the general population, according to the researchers.
The primary outcomes were all-cause in-hospital mortality, length of stay, cardiogenic shock, acute kidney injury, the likelihood of receiving left heart catheterization with or without PCI and 30-day readmission rates.
Researchers found that, compared with the general population, acute MI in the heart transplant group was associated with longer length of stay (5.9 days vs. 4.9 days), more cardiogenic shock (8.8% vs. 6.4%), more acute kidney injury (26.2% vs. 17.6%), less catheterization (59.7% vs. 75.1%), less use of PCI (35.2% vs. 50%) and a higher 30-day readmission rate (21.3% vs. 14.4%; P < .01 for all).
The researchers found no significant difference in all-cause mortality between patients with acute MI with heart transplant and those without (6.8% vs. 5.4%; P = .07).
“To our knowledge, this study is the first to compare the in-hospital outcomes of [acute] MI in [heart transplantation] vs. non-[heart transplantation] patients and represents the largest cohort of [acute] MI in [heart transplantation] ever reported,” the researchers wrote. “We believe it has several important clinical implications. [Acute] MI is a potential complication in [heart transplantation] patients [and a] high index of suspicion is needed to prevent any delay in the diagnosis and appropriate treatment, even with the absence of typical symptoms, by a team with expertise in [heart transplantation].” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.
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