Lu SF, et al. - The topics of exploration herein were the clinical features, management strategies and outcomes of acute myocardial infarction in patients with paraplegia. Enrollees with paraplegia exhibited distinct clinical characteristics and comorbidity profiles. Such individuals displayed less likelihood of receiving revascularization therapy and presented with higher in-hospital mortality compared to those without paraplegia. As per findings, candidates with paraplegia who underwent revascularization correlated with better clinical outcomes. It was particularly noted that those who were treated with percutaneous coronary intervention demonstrated substantially lower in-hospital mortality than that for those with coronary artery bypass grafting.

Methods

• Researchers detected acute myocardial infarction in patients with or without paraplegia in the New York State Inpatient Database between 2007 and 2013.
• They undertook a comparative assessment of the clinical comorbidities, management strategies (medical therapy, cardiac catheterization without revascularization, percutaneous coronary intervention, and coronary artery bypass grafting), and their associated outcomes with the aid of the propensity-score-matching analysis.

Results

• Out of 402,569 adult patients with acute myocardial infarction, 1,400 presented with a concomitant diagnosis of paraplegia.
• Subjects with paraplegia were younger, exhibited a greater tendency of being black, and illustrated a higher prevalence of hypertension, anemia, congestive heart failure, coagulopathy, and depression, but a lower prevalence of diabetes, hyperlipidemia, obesity, chronic lung disease, and renal failure compared to those without paraplegia.
• Acute myocardial infarction patients with paraplegia displayed a greater likelihood of receiving medical therapy without a diagnostic cardiac catheterization than those without (83.7% vs 64.5%, P < 0.001).
• Revascularization was performed in 9% of the acute myocardial infarction patients with paraplegia, which appeared to be substantially lower than the use of revascularization in a propensity-score-matched cohort without paraplegia [percutaneous coronary intervention: 7.1% vs 17.5% (P < 0.001); bypass grafting: 1.9% vs 6.0% (P < 0.001)].
• Individuals with paraplegia demonstrated higher in-hospital mortality than those without [22.4% (95% confidence interval (CI), 20.2%-24.6%) vs 16.8% (15.9%-17.7%)], with regard to the clinical outcome.
• Among the patients with paraplegia, lower in-hospital morality [9.5% (4.3%-14.6% ) vs 22.0% (18.8%-25.2%)], shorter length of stay (days) [13.0 (9.9-16.0) vs 16.9 (15.1-18.8)], higher hospital charges ($) [130,079 (83,988-176,170) vs 92,125 (72,109-112,140)] were reported among the subcohort that received revascularization, and they were more likely to be discharged to home [28.3% (20.4%-36.2%) vs 11.8% (9.3%-11.4%)] than the propensity-score-matched subcohort without revascularization.
• It was also brought to light that the paraplegic subcohort underwent coronary artery bypass grafting that correlated with higher in-hospital mortality [21.7% (4.5%-38.9%) vs 1.7% (0-4.1%)], longer length of stay (days) [24.8 (17.7-32.0) vs 14.2 (11.2-17.1)], higher hospital charges ($) [231,323 (182,658-279,988) vs 144,449 (122,157-166,741)], than the propensity-score-matched subcohort that received percutaneous coronary intervention.