VPB0016 - Outcomes of ST-elevation Myocardial Infarction in Patients with Antiphospholipid Syndrome

Background: Antiphospholipid syndrome (APS) is an autoimmune disorder associated with arterial and venous thrombosis. It is also known to increase the risk of coronary artery disease and myocardial infarction by twofold. The impact of APS on ST-elevation myocardial infarction (STEMI) remains to be elucidated.

Aims: To identify the outcomes of STEMI in patients with anti phospholipid syndrome

Methods: We conducted a retrospective analysis of the 2016 to 2018 Nationwide Inpatient Sample. Adult patients with APS (age ≥18) undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) were selected using the ICD-10 diagnosis and procedure codes. Discharge-level weight analysis was used to produce a national estimate. Propensity score matching (1:1) with age, female and comorbidity burden was performed and outcomes were compared between matched cohorts.

Results: During the study period, a total of 645,935 STEMI patients were identified of which 390 patients (0.06%) also had APS. In those who developed STEMI, 129,160 APS and non-APS patients were propensity-matched. In-hospital mortality (12.82% vs 10.9%, p = 0.5), PCI rate (61.5% vs 68.2%. p = 0.7), medical treatment rate (37.2% vs 28.0%, p = 0.5), major adverse cardiac events (MACE) (15.4% vs 11.0%, p = 0.5) and cardiogenic shock (11.5% vs 13.2%, p =1.0) were similar in APS and non-APS population. However, APS was associated with lower rate of coronary artery bypass graft surgery (CABG) (2.6% vs 5.1%, p = 0.006) and longer length of stay (8.1 ± 1.4 vs 4.7 ± 0.02, p = 0.014).

Conclusion(s): The outcomes of STEMI including in-hospital mortality, major cardiovascular events, rate of PCI and medical treatment were similar in patients with APS and without APS. The lower rate of CABG was identified in patients with APS who developed STEMI but required a longer length of stay when compared to patients without APS.