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

• 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
• Journal Title: World J Cardiol
• Volume: Volume 11, Number 5
• Publisher: Baishideng Publishing Group Inc | 2019-05-26, Pages 137-148
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.4330/wjc.v11.i5.137
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Health Care Management
• Keywords: Acute coronary syndrome; Coronary artery bypass grafting; Gout; In-hospital outcomes; Myocardial infarction; Percutaneous coronary intervention; Revascularization; Serum uric acid; Unstable angina

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.