Published online May 26, 2019. doi: 10.4330/wjc.v11.i5.137
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
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.
Limited data exist on impact of gout on in-hospital outcome of ACS in terms of healthcare utilization and post-revascularization outcomes.
The study aimed to evaluate the impact of gout on in-hospital outcomes of ACS hospitalizations, subsequent healthcare burden and predictors of post-revascularization inpatient mortality.
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.
Out of 3144744 ACS-related hospitalizations, 105198 (3.35%) patients had gout. The ACS-gout cohort were more often older white males with a higher prevalence of comorbidities. ACS-gout cohort showed comparativly higher prevalence of Coronary artery bypass grafting. 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.
Gout was not independently associated with an increased risk of post-revascularization in-hospital mortality in ACS. However, gout did increase post-revascularization complications.
This study may help clinicians making evidence-based decision in patients with history of gout who are admitted with primary diagnosis of ACS and have undergone re-vascularization.