Aortic Stenosis Increases the Risk of Mortality in Hospitalization for Myocardial Infarction

Background: Valvular aortic stenosis (AS) commonly co-exists with coronary artery disease, but there is limited information on the effect of AS on mortality in the setting of acute myocardial infarction (MI).Using National Inpatient Sample data from years 2005-2014, we analyzed the association between presence of AS and in-hospital mortality in MI patients.Methods: We assessed frequency and estimated mortality differences in patients who had percutaneous coronary intervention (PCI) versus those patients who did not receive PCI. Generalized estimating equation models were used to control for potential confounders and withinhospital variation.Results: We evaluated a total of 1,201,176 patients admitted for MI, including 56,037 patients (4.7%) with concomitant AS.Patients with both MI and AS were more likely to die during hospitalization when compared to patients with MI but without AS (OR 1.15 [95% CI, 1.11-1.19]);this finding was similar for patients admitted for ST-elevation MI or non-ST-elevation MI (P=0.35).MI patients with AS less often received PCI (20.2% of AS patients versus 46.1% of non-AS patients; p<0.0001).Those patients with AS who received PCI had lower mortality risk compared to AS patients who did not undergo PCI (OR 0.66 [95% CI, 0.59-0.73]).Conclusion: Concurrent AS increases odds of in-hospital mortality in patients with acute MI.An important contributing factor for this increased mortality risk may be the significantly lower rate of PCI in AS patients.These results suggest a need to carefully consider the appropriateness of conservative versus aggressive revascularization strategies in patients with valvular AS associated with acute MI.