A-21 | Patients with Spontaneous Coronary Artery Dissection and Co-existing Heart Failure Have Alarmingly Poor Outcomes; A US Propensity Matched Cohort Study

Background: End stage renal disease is significantly associated with worse cardiovascular outcomes.Although there has been a rising trend in the number of patients receiving kidney transplants (KTRs), cardiovascular disease still remains the leading cause of mortality in these patients.We sought to evaluate various in-hospital outcomes of NSTEMI in post kidney transplant recipients.Methods: Using the National Inpatient Sample (NIS) Database from 2017-2021, we conducted a retrospective analysis of patients admitted with NSTEMI using the ICD 10 code (I214).Our primary population included patients 18 years and older with a primary diagnosis of NSTEMI.Patients were divided into two groups, either KTRs or not.Using a multivariate analysis, we compared the odds of various in hospital outcomes and adjusted for confounders.Results: There were 2178024 admissions for NSTEMI, out of which 6990(0.32%) were KTRs.The primary outcomes of interest were inhospital mortality, length of stay (LOS)and total hospitalization charges (TOTCHG).Secondary outcomes included need for coronary artery bypass grafting (CABG), cardiac arrest (CA), cardiogenic shock (CS), acute kidney injury (AKI), percutaneous coronary intervention (PCI), renal replacement therapy (RRT) and bleeding.There was higher mortality (adjusted odds ratio (aOR):1.32,CI: 1.015-1.726,p < 0.038), AKI (aOR:1.32,CI: 1.15-1.50,p<0.00) and RRT (aOR:2.42,CI:2.02-2.88,p<0.00) with decreased CABG (aOR:0.44,CI:0.36-0.55,p<0.00),mean TOTCHG ($-16805, CI: $ -23489-$-10121, p < 0.00) and mean LOS (-0.5 days, CI: -0.76 --0.18, p < 0.002) in the KTR group.There was no difference in PCI (aOR 1.02, CI: 0.90 -1.15, p<0.78), bleeding (aOR:1.15,CI:0.65-2.01,p<0.63),CA (aOR 0.97, CI; 0.63-1.5,p<0.88) and CS (aOR:0.89,CI:0.69-1.15,p <0.37) in both groups.Conclusions: KTRs still remain at a high risk of mortality from NSTEMI compared to the general population.The increased mortality and persistent renal complications highlight the need for continued research and tailored management strategies in this unique population.There is the need for continuous aggressive control of other cardiovascular risk factors to prevent these outcomes.