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Cardiovascular disease has become a leading cause of death for individuals with paraplegia. This is the first clinical study in the literature to investigate the clinical outcomes and treatment of AMI patients with paraplegia.
We identified AMI patients with paraplegia cohort by using principal diagnosis of AMI (ICD-9 codes 401.xx) and a concomitant diagnosis of paraplegia (344.1) and/or quadriplegia/tetraplegia (344.0) in New York State Inpatient Database (NY-SID) from 2007 to 2013. Cardiac catheterization procedures with or without intervention were identified by procedural codes 37.22, 37.23, and 88.5x. PCI was identified by codes 00.66, 36.01, 36.05, 36.07, and 36.09. CABG by code 44. Propensity score (PS) matching analysis was used to compare outcomes of patients underwent various treatments adjusted for their comorbidities.
Total of 1,400 patients with paraplegia were identified from 402,569 adult AMI admissions (3.5 per 1,000 admissions) with average age of 67.8±14.6 with 41% female, 65% white and 16% black. In addition to paraplegia, these patients have significant comorbidities such as hypertension (52%), diabetes mellitus (30%), and hyperlipidemia (25%). The overall in-hospital mortality was high (22.4%, 95% CI 20.2-24.6). The majority underwent medical therapy without a cardiac catheterization (1172 out of 1400, 83.7%), with 101 (7.2%) who underwent a diagnostic cardiac catheterization without revascularization, 100 (7.1%) who received PCI, and 27 (1.9%) patients who underwent CABG. Comparison of 127 treated with revascularization versus without (635 PS matched patients) found that revascularization was associated with lower mortality (9.5 (CI 4.3-14.6) vs. 22.0 (18.8-25.3), p <0.01), shorter LOS (13.0 (9.9-16.0) vs. 16.9 (15.1-18.8), p = 0.08), but higher hospital charges ($130,000 ($110,000-$150,000) vs. $92,000 ($84,000-$101,000), p <0.001). Comparison between PCI (115) and PS-matched CABG (23) found that PCI was associated with significantly lower mortality (1.7 (0-4.1) vs. 21.7 (4.5-38.9), p<0.001), shorter LOS (14.2 (11.2-17.1) vs. 24.8 (17.7-32.0), p<0.001) and lower hospital charges ($144,000 ($122,000–$167,000) vs. $231,000 ($183,000-$280,000), p<0.01).
AMI in patients with paraplegia is a small but unique subgroup of AMI patients that deserves attention. These patients had high in-hospital mortality, low rate of using invasive diagnostic and treatment approaches. Propensity score matching analysis revealed that revascularization was associated with favorable outcome. PCI was associated with significantly better outcome than CABG.