S2358 Nationwide Trends in Mortality From Acute Myocardial Infarction With Liver Diseases: A Joinpoint Regression Analysis (1999–2023)

Introduction: Cardiovascular disease is the leading cause of death in the United States. 3.2 million deaths were reported due to acute myocardial infarction (AMI) from 1999 to 2022. Meanwhile, 4.5 million people are formally diagnosed with liver disease (LD) in the United States, which is an underreported estimate. In patients with LD, the diagnosis and management of AMI are more challenging because of increased baseline cardiac biomarkers and treatment-related bleeding complications. However, data on mortality trends due to AMI in the LD population remain unknown. Methods: A retrospective analysis using data obtained from the CDC WONDER Multiple Cause of Death database. Cases were identified using ICD codes for AMI as an underlying cause and liver disease as a contributing condition. Age-adjusted mortality rates (AAMR) from 1999 to 2023 were analyzed with Joinpoint regression, stratified by sex, to identify inflection points and estimate the annual percent change (APC). Results: The AAMR for AMI in patients with LD revealed a biphasic V-shaped trend from 1999 to 2023; the rates declined initially from 1999 till an inflection point around 2012, after which a rise was observed till 2023. A Joinpoint regression stratified by sex revealed that among men, the AAMR declined by 3.43% annually between 1999 and 2012, followed by an increase of 3.94% annually from 2012 to 2023. Similarly, in women, the AAMR exhibited a decline of 3.1% annually from 1999 to 2012, followed by an increase of 4.68% from 2012 onward. For all years, men had a higher AAMR than women. The highest AMI-related mortality in LD patients was observed in 2021, which included 2634 deaths. The crude mortality rate and AAMR show an upward trend between 2018 and 2023. Conclusion: After a decade-long decline, AMI mortality in patients with LD has risen steadily since 2012. The simultaneous increase in crude mortality rate and AAMR from 2018-2023 reveals that this change cannot be attributed to demographic aging alone. A close link between cardiac and hepatic health is highlighted in our study. Future studies should focus on underlying driving factors like metabolic syndrome trends and treatment disparities, along with exploring coordinated care management plans.