Abstract 14003: Outcomes With Invasive versus Conservative Management of Myocardial Infarction in Patients With Sepsis

Background: Patients hospitalized with sepsis may be predisposed to myocardial infarction (MI). The incidence, treatment, and outcomes of MI in sepsis have not been studied. Methods: We analyzed data from the National Inpatient Sample from 2002 to 2011 for patients with a diagnosis of sepsis (CCS category 2). The incidence of MI as a non-primary diagnosis was evaluated. Propensity score matching was performed (1:1, without replacement) to identify patients with secondary MI and sepsis who were managed invasively (defined as cardiac catheterization, percutaneous coronary intervention (PCI), or coronary artery bypass graft surgery (CABG)) or conservatively. The primary outcome was in-hospital all-cause mortality. Results: A total of 2,570,098 patients had a diagnosis of sepsis. MI developed in 118,183 (4.6%) patients, the majority with non-ST elevation MI (71.4%). In-hospital mortality was higher among patients with MI and sepsis than for those with sepsis alone (35.8% vs. 16.8%, p<0.0001; adjusted OR 1.24, 95% CI 1.22-1.26). Among patients with MI, 11,899 (10.1%) underwent an invasive management strategy with revascularization in 4668 (39.2%). PCI was performed in 3,413 patients (73.1%), CABG in 1,165 (25.0%), and both CABG and PCI in 90 (1.9%) cases. Trends in mortality are shown in the Figure. In a propensity-matched cohort of 23,708 patients with MI, invasive management was associated with a lower mortality than conservative management (19.0% vs. 33.4%, p<0.001; OR 0.47, 95% CI 0.44-0.50). In subgroups that underwent revascularization, the odds of mortality were consistently lower than corresponding matched subjects from the conservative group. Conclusions: Myocardial infarction frequently complicates sepsis and is associated with a significant increase in in-hospital mortality. Patients managed invasively had a lower mortality than those managed conservatively, and patients with MI complicating sepsis may warrant more aggressive management.