Bleeding Risk More Than Doubled for AMI Hospitalization With ET

Patients hospitalized with acute myocardial infarction (AMI) who had essential thrombocythemia (ET) were associated with an increased risk of bleeding compared with those without ET, whereas no difference was observed for in-hospital outcomes among individuals with AMI hospitalization and polycythemia vera (PV) after propensity score matching (PSM) was applied. Results were published in Journal of the American Heart Association.

As 2 chronic Philadelphia-negative myeloproliferative neoplasms (Ph-MPNs), ET and PV are rare conditions associated with an increased risk of thrombosis, morbidity, and mortality. Patients with ET and PV are additionally prone to excessive bleeding, noted researchers, which may exacerbate outcomes for those who develop AMI, a common complication in these patient populations.

“AMI treatment involves systemic antithrombotic and anticoagulation therapy, especially for patients treated with percutaneous coronary intervention (PCI). As standard practice, heparin or other anticoagulation is used to achieve optimal activated clotting time,” said the study authors. “Optimal management of AMI is crucial for the proper care of this unique population…However, because of the rarity of [ET and PV], there are limited data on their prevalence, management strategies, and impact on in-hospital outcomes.”

A retrospective cohort study was conducted utilizing October 2015-2019 data from the US National Inpatient Sample (NIS), the largest inpatient database in the United States, to assess hospitalizations among patients with AMI who had and did not have ET and PV.

Patients with ST-segment–elevation myocardial infarction (STEMI) and those with a primary diagnosis of non–STEMI (NSTEMI), identified via International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding, were included in the analysis.

The prevalenced of ET and PV were examined among the participants, with the primary outcome being in-hospital mortality and secondary outcomes including major adverse cardiac or cerebrovascular events (MACCEs), stroke, and bleeding (hemorrhagic stroke, gastrointestinal bleeding, and blood transfusion). MACCEs were defined by a composite of all-cause mortality, stroke, and cardiac complications (hemopericardium and cardiac tamponade necessitating pericardiocentesis). The Healthcare Cost and Utilization Project–provided Elixhauser Comorbidity Software Refined for ICD10-CM was used to identify comorbidities.

PSM was utilized to balance the baseline difference between the hospitalizations with ET and PV, which accounted for age, sex, race, hypertension, diabetes, obesity, smoking status, atrial fibrillation, prior stroke, prior PCI, prior myocardial infarction, prior coronary artery bypass grafting, chronic lung disease, peripheral arterial disease, family history of coronary artery disease, STEMI presentation, hypothyroidism, autoimmune disease, dementia, and PCI.

A total of 574,350 weighted hospitalizations were included in the final cohort: 572,314 (99.64%) hospitalizations without an ET or PV; 1526 (0.27%) with ET; and 547 (0.1%) with PV. Prior to PSM, worse in-hospital outcomes were shown among patients hospitalized with AMI with ET and PV compared with those without ET and PV:

• AMI hospitalization with ET was associated with increased risk of in-hospital mortality (7.1% vs 5.7%; odds ratio [OR], 1.14; 95% CI, 1.04-1.24), MACCEs (12.6% vs 9%; OR, 1.36; 95% CI, 1.26-1.45), bleeding (12.7% vs 5.8%; OR, 2.28; 95% CI, 2.13-2.44]), and stroke (3.1% vs 1.8%; OR, 1.66; 95% CI, 1.46-1.89)
• AMI hospitalization with PV was associated with an increased risk of in-hospital mortality (7.8% vs 5.7%; OR, 1.21; 95% CI, 1.04-1.39) and MACCEs (12.0% vs 9%; OR, 1.18; 95% CI, 1.05-1.33).
  

After PSM, the risk of bleeding among patients with AMI hospitalization and ET was the only in-hospital outcome to remain significant, with risk more than doubled compared with those with hospitalizations without ET and PV (12.6% vs 6.1%; OR, 2.22; 95% CI, 1.70-2.90). Subgroup analyses further revealed that for patients with AMI hospitalization with ET, treatment with PCI was associated with the highest bleeding risk, with a more than 2-fold increased risk in bleeding observed (OR, 3.44; 95% CI, 3.06–3.87).

AMI hospitalization with PV was not associated with worse in-hospital outcomes after PSM. The lack of clinical details, such as medication, biochemistry, and imaging data, in the administrative database, as well as the absence of long-term follow-up data in the NIS data set, were cited as potential limitations of the study findings.

“AMI hospitalization with ET is associated with high bleeding risk before and after PSM, particularly for hospitalized patients treated with PCI. The management of AMI with ET or PV is challenging and requires a multidisciplinary and patient-centered approach to ensure safety and improve outcomes,” concluded the researchers.

Reference

Wu J, Fan YZ, Zhao W, et al. In-hospital outcomes of acute myocardial infarction with essential thrombocythemia and polycythemia vera: Insights from the National Inpatient Sample. ​​J Am Heart Assoc. 2022;11(24):e027352. doi:10.1161/JAHA.122.027352