BACKGROUND: The prevalence of multimorbidity in patients with acute myocardial infarction (AMI) is increasing. It is unclear whether comorbidities cluster into distinct phenogroups and whether are associated with clinical trajectories.
METHODS: Survey-weighted analysis of the United States Nationwide Inpatient Sample (NIS) for patients admitted with a primary diagnosis of AMI in 2018. In-hospital outcomes included mortality, stroke, bleeding, and coronary revascularisation. Latent class analysis of 21 chronic conditions was used to identify comorbidity classes. Multivariable logistic and linear regressions were fitted for associations between comorbidity classes and outcomes.
RESULTS: Among 416,655 AMI admissions included in the analysis, mean (±SD) age was 67 (±13) years, 38% were females, and 76% White ethnicity. Overall, hypertension, coronary heart disease (CHD), dyslipidaemia, and diabetes were common comorbidities, but each of the identified five classes (C) included ≥1 predominant comorbidities defining distinct phenogroups: cancer/coagulopathy/liver disease class (C1); least burdened (C2); CHD/dyslipidaemia (largest/referent group, (C3)); pulmonary/valvular/peripheral vascular disease (C4); diabetes/kidney disease/heart failure class (C5). Odds ratio (95% confidence interval [CI]) for mortality ranged between 2.11 (1.89-2.37) in C2 to 5.57 (4.99-6.21) in C1. For major bleeding, OR for C1 was 4.48 (3.78; 5.31); for acute stroke, ORs ranged between 0.75 (0.60; 0.94) in C2 to 2.76 (2.27; 3.35) in C1; for coronary revascularization, ORs ranged between 0.34 (0.32; 0.36) in C1 to 1.41 (1.30; 1.53) in C4.
CONCLUSIONS: We identified distinct comorbidity phenogroups that predicted in-hospital outcomes in patients admitted with AMI. Some conditions overlapped across classes, driven by the high comorbidity burden. Our findings demonstrate the predictive value and potential clinical utility of identifying patients with AMI with specific comorbidity clustering.
Zghebi, Salwa; Rutter, Martin; Sun, Louise; Ullah, Waqas; Rashid, Muhammad; Ashcroft, Darren; Steinke, Douglas; Weng, Stephen; Kontopantelis, Evangelos; and Mamas, Mamas, "Comorbidity Clusters and In-Hospital Outcomes in Patients Admitted with Acute Myocardial Infarction in the USA: A National Population-Based Study" (2023). Division of Cardiology Faculty Papers. Paper 137.
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S2 Fig Individual radar charts.pdf (147 kB)
S3 Fig Radar charts for percentage.pdf (134 kB)
S4 Fig Predictive margins.pdf (199 kB)
S1 Table ICD-10.pdf (138 kB)
S2 Table Comparison of AICBIC values.pdf (124 kB)
S3 Table Significance testing.pdf (145 kB)
S4 Table Crude rates of in-hospital outcomes.pdf (151 kB)
S5 Table Odds ratios.pdf (176 kB)
S6 Table Regression coefficients.pdf (153 kB)
S7 Table Incidence rate ratios (IRRs).pdf (153 kB)
Submitted filename Response to Reviewers.pdf (267 kB)