Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. May 26, 2019; 11(5): 137-148
Published online May 26, 2019. doi: 10.4330/wjc.v11.i5.137
Impact of gout on in-hospital outcomes of acute coronary syndrome-related hospitalizations and revascularizations: Insights from the national inpatient sample
Rupak Desai, Tarang Parekh, Hemant Goyal, Hee Kong Fong, Dipen Zalavadia, Nanush Damarlapally, Rajkumar Doshi, Sejal Savani, Gautam Kumar, Rajesh Sachdeva
Rupak Desai, Gautam Kumar, Rajesh Sachdeva, Division of Cardiology, Atlanta VA Medical Center, Decatur, GA 30033, United States
Tarang Parekh, Department of Health Administration and Policy, George Mason University, Fairfax, VA 22030, United States
Hemant Goyal, Department of Internal Medicine, Macon University School of Medicine, Macon, GA 31207, United States
Hee Kong Fong, Department of Internal Medicine, University of Missouri-Columbia, Columbia, MO 65212, United States
Dipen Zalavadia, Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA 18503, United States
Nanush Damarlapally, Department of Health Sciences, Coleman College of Health Sciences, Houston, TX 77030, United States
Rajkumar Doshi, Department of Internal Medicine, University of Nevada School of Medicine, Reno, NV 89557, United States
Sejal Savani, Public Health, New York University, New York, NY 10010, United States
Gautam Kumar, Rajesh Sachdeva, Division of Cardiology, Emory University School of Medicine, Atlanta, GA 30322, United States
Rajesh Sachdeva, Division of Cardiology, Morehouse School of Medicine, Atlanta, GA 30310, United States
Author contributions: Desai R and Parekh T equal contribution to the manuscript; Desai R, Sachdeva R and Kumar G contributed to conception and design; Desai R and Doshi R contributed to provision of study material or patients; all authors contributed to collection and assembly of data, data analysis and interpretation, manuscript writing and final approval of manuscript.
Institutional review board statement: This study was exempt from an IRB review.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data from a publically accessible dataset.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hemant Goyal, FACP, MBBS, MD, Assistant Professor, Department of Internal Medicine, Macon University School of Medicine, 707 Pine St., Macon, GA31207, United States. doc.hemant@yahoo.com
Telephone: +1-478-3015862
Received: February 20, 2019
Peer-review started: February 22, 2019
First decision: March 15, 2019
Revised: April 2, 2019
Accepted: May 22, 2019
Article in press: May 22, 2019
Published online: May 26, 2019
Processing time: 94 Days and 7.2 Hours
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.

Keywords: Gout; Serum uric acid; Acute coronary syndrome; Unstable angina; Myocardial infarction; Revascularization; Percutaneous coronary intervention; Coronary artery bypass grafting; In-hospital outcomes

Core tip: 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. In this largest nationwide cohort, we identified 3144744 ACS-related hospitalizations, of which 105198 (3.35%) also had gout. Coronary artery bypass grafting was required more often in the ACS-gout cohort. Post-revascularization (percutaneous coronary intervention/coronary artery bypass grafting) complications including cardiovascular (3.2% vs 2.9%), respiratory (3.5% vs 2.9%), and hemorrhage (3.1% vs 2.7%) were higher and raised the mortality odds whereas all-cause mortality was lower (2.2% vs 3.0%) in the ACS-gout cohort. Mean length of stay, transfers and hospital charges were higher in the ACS-gout cohort.