Resident Doctor University of Manitoba Winnipeg, Manitoba, Canada
Background: Pulmonary hypertension (PH) is associated with right ventricular dysfunction, adverse hemodynamics, and poor cardiovascular outcomes. Hospitalized patients with PH experience increased morbidity and mortality, particularly in the setting of cardiovascular events such as heart failure and acute coronary syndrome (ACS). Notably, PH independently correlates with worse outcomes in cardiac intensive care units, where ACS represents one of the most ominous admission diagnoses in this population. Moreover, patients with PH are less likely to receive invasive treatments such as percutaneous coronary intervention (PCI) in the cardiac intensive care units, potentially contributing to their poorer outcomes. Despite this, limited large-scale data exist specifically evaluating the impact of PH in patients with ST-elevation myocardial infarction (STEMI), emphasizing the need for real-world evidence to guide management in this high-risk cohort.
METHODS AND RESULTS: We utilized the Nationwide Inpatient Sample (NIS) which captures approximately 20% of all US in-patient hospitalizations. We created a cohort of adult patients admitted with a STEMI via ICD10-coding. Multivariate logistic regression modelling was used to control for our main outcome of in-hospital mortality after STEMI. We identified 288,674 patients admitted with STEMI from the 2016-2022 NIS samples. Of these there were 9,223 (3.2%) patients who also had a diagnosis of pHTN. The unadjusted mortality rate for patients with pHTN was 19.4% compared with 10.7% in the non-pHTN group (p < 0.01). Patients with pHTN were less likely to receive both PCI (50.6% pHTN vs 70.3% non-PHTN, p< 0.01) and angiography (66.3% pHTN vs 79.0% non-pHTN, p< 0.01). After multivariate analysis including the presence of shock, cardiac arrest and mechanical ventilation, patients with pHTN had significantly higher risk of mortality compared to non-pHTN patients (OR 1.16 95% CI 1.09-1.24, p< 0.01).
Conclusion: Patients with PH presenting with STEMI represent a particularly high-risk subgroup, with markedly increased mortality and reduced likelihood of receiving invasive interventions such as PCI. These findings underscore the urgent need for targeted clinical strategies and tailored risk stratification in ACS patients with coexisting PH, with potential implications for future guideline development.
