Impact of gout on in-hospital outcomes of acute coronary syndrome-related hospitalizations and revascularizations: Insights from the national inpatient sample.

• Type of Material: Article
• Authors: Rupak Desai, Atlanta VA Medical Center; Tarang Parekh, George Mason University; Hemant Goyal, Macon University; Hee Kong Fong, University of Missouri Columbia; Dipen Zalavadia, Wright Center for Graduate Medical Education; Nanush Damarlapally, Coleman College of Health Sciences; Rajkumar Doshi, University of Nevada; Sejal Savani, New York University; Gautam Kumar, Atlanta VA Medical Center; Rajesh Sachdeva, Emory University
• Language: English
• Date: 2019-05-26
• Publisher: Baishideng Publishing Group Inc
• Publication Version: Final Published Version
• Copyright Statement: ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.4330/wjc.v11.i5.137
• Title of Journal or Parent Work: World J Cardiol
• Volume: 11
• Issue: 5
• Start Page: 137
• End Page: 148
• Keywords: Coronary artery bypass grafting; Serum uric acid; Unstable angina; Revascularization; Percutaneous coronary intervention; Gout; Myocardial infarction; In-hospital outcomes; Acute coronary syndrome
• Research Categories: Health Sciences, Health Care Management; Health Sciences, Medicine and Surgery

Abstract

BACKGROUND: Previous studies have established a role of gout in predicting risk and prognosis of cardiovascular diseases. However, large-scale data on the impact of gout on inpatient outcomes of acute coronary syndrome (ACS)-related hospitalizations and post-revascularization is inadequate. AIM: To evaluate the impact of gout on in-hospital outcomes of ACS hospitalizations, subsequent healthcare burden and predictors of post-revascularization inpatient mortality. METHODS: We used the national inpatient sample (2010-2014) to identify the ACS and gout-related hospitalizations, relevant comorbidities, revascularization and post-revascularization outcomes using the ICD-9 CM codes. A multivariable analysis was performed to evaluate the predictors of post-revascularization in-hospital mortality. RESULTS: We identified 3144744 ACS-related hospitalizations, of which 105198 (3.35%) also had gout. The ACS-gout cohort were more often older white males with a higher prevalence of comorbidities. Coronary artery bypass grafting was required more often in the ACS-gout cohort. Post-revascularization complications including cardiac (3.2% vs 2.9%), respiratory (3.5% vs 2.9%), and hemorrhage (3.1% vs 2.7%) were higher whereas all-cause mortality was lower (2.2% vs 3.0%) in the ACS-gout cohort (P < 0.001). An older age (OR 15.63, CI: 5.51-44.39), non-elective admissions (OR 2.00, CI: 1.44-2.79), lower household income (OR 1.44, CI: 1.17-1.78), and comorbid conditions predicted higher mortality in ACS-gout cohort undergoing revascularization (P < 0.001). Odds of post-revascularization in-hospital mortality were lower in Hispanics (OR 0.45, CI: 0.31-0.67) and Asians (OR 0.65, CI: 0.45-0.94) as compared to white (P < 0.001). However, post-operative complications significantly raised mortality odds. Mean length of stay, transfer to other facilities, and hospital charges were higher in the ACS-gout cohort. CONCLUSION: Although gout was not independently associated with an increased risk of post-revascularization in-hospital mortality in ACS, it did increase post-revascularization complications.