Impact and Outcomes of Patients with Congestive Heart Failure Complicating Non-ST-Segment Elevation Myocardial Infarction, Results from a Nationally-Representative United States Cohort

Introduction: Congestive heart failure (CHF) is seen in up to 13-25% of patients with NSTEMI. Recent data describing the impact of congestive heart failure (CHF) on in-hospital outcomes in patients with non-ST-segment elevation myocardial infarction (NSTEMI) in the United States is limited. We sought to examine the in-hospital outcomes, and management of CHF in patients admitted to the hospital with NSTEMI. Methods: National Inpatient Sample (NIS) database (2010-2014) was analyzed to identify patients with NSTEMI using ICD-9-CM cocks. The primary outcome was in-hospital mortality. Propensity score-matching analysis compared mortality in CHI patients to matched controls without CHF. Results: Of 247,624 patients with NSTEMI, 84,115 (34%) had CHF. Patients with CHF were less likely to receive percutaneous coronary intervention (PCI) [20.48% vs. 40.9%, P < 0.001] or coronary artery bypass grafting (CABG) [8.2% vs 9.6%, P < 0.001] during hospitalization. Also, they had longer lengths of stay and higher risk for in-hospital adverse outcomes. CHI was the strongest predictor of in-hospital death. The increased mortality risk was persistent after propensity matching (RR 1.27; 95% CI 1.22 to 1.33). Conclusion: CHF among patients with NSTEMI is associated with increased risk for in-hospital mortality and adverse outcomes. (C) 2018 Elsevier Inc. All rights reserved.