The American Journal of Medicine
Volume 119, Issue 10 , Pages 843-850, October 2006

Acute, Severe Noncardiac Conditions in Patients with Acute Myocardial Infarction

  • Judith H. Lichtman, PhD, MPH

      Affiliations

    • Section of Chronic Disease Epidemiology, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn
    • ,
  • Amir Fathi, MD

      Affiliations

    • Department of Medicine, Massachusetts General Hospital, Boston, Mass
    • ,
  • Martha J. Radford, MD

      Affiliations

    • Division of Cardiology, Department of Medicine, New York University Medical Center, New York, NY
    • ,
  • Zhenqiu Lin, PhD

      Affiliations

    • Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Conn
    • ,
  • Caroline S. Loeser, MD

      Affiliations

    • Department of Medicine, Yale University School of Medicine, New Haven, Conn
    • ,
  • Harlan M. Krumholz, MD, SM

      Affiliations

    • Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Conn
    • Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn
    • Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Conn
    • Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, Conn.
    • Corresponding Author InformationRequests for reprints should be addressed to Harlan M. Krumholz, Yale University School of Medicine, 333 Cedar Street, PO Box 208088, New Haven, CT 06520.8088.

Received in revised form 20 March 2006

Abstract 

Purpose

The study’s purpose was to determine the prevalence and prognostic importance of acute, severe, noncardiac conditions present at the time of an acute myocardial infarction (AMI).

Methods

We identified consecutive patients with AMI who were discharged from Yale-New Haven Hospital between January 1, 1997, and June 30, 2000. Acute, noncardiac conditions that were present at admission were abstracted from patient records and graded by severity (imminent threat to life; other significant condition that would warrant admission). We examined the prognostic importance of these conditions on hospital mortality in multivariable logistic models. The study included 1145 patients with AMI, of whom 8.5% (n=97) presented with an acute, life-threatening, noncardiac condition at admission and 19.5% (n=223) presented with another significant noncardiac condition.

Results

Hospital mortality was 25.8% and 9.0%, respectively, for patients who presented with life-threatening and other significant noncardiac conditions, compared with 4.6% for patients without either of these conditions. In multivariable analysis, life-threatening noncardiac conditions were associated with increased hospital mortality after adjusting for demographic factors, medical history, clinical presentation, cardiac severity, and initial therapy (odds ratio 2.5; 95% confidence interval [CI], 1.2-5.2). No increased hospital mortality risk was found for other significant noncardiac conditions in the risk-adjusted analyses (odds ratio 1.0; 95% CI, 0.5-1.7).

Conclusions

A subgroup of patients with AMI presented with a life-threatening noncardiac condition, which was associated with a marked increase in the risk of death during the hospitalization. Despite the excessive mortality risk associated with concomitant noncardiac conditions, this subset of patients with AMI are poorly described in current literature.

Keywords: Acute myocardial infarction, Mortality, Risk factors

 

 Dr. Lichtman is supported by grant number 1 K01 DP000085-01 from the Centers for Disease Control and Prevention (CDC). The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of CDC.

PII: S0002-9343(06)00576-6

doi:10.1016/j.amjmed.2006.03.040

The American Journal of Medicine
Volume 119, Issue 10 , Pages 843-850, October 2006

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