Impact of gout on in-hospital outcomes of acute coronary syndrome-related hospitalizations and revascularizations: Insights from the national inpatient sample

doi:10.4330/wjc.v11.i5.137

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World Journal of Cardiology

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1949-8462

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Cardiol. May 26, 2019; 11(5): 137-148
Published online May 26, 2019. doi: 10.4330/wjc.v11.i5.137

Table 1 Baseline characteristics of acute coronary syndrome hospitalizations without vs with gout (n = 3144744)

Variables	Without gout(n = 3039546)	With gout(n = 105198)	P value
Age (yr) at hospitalization			< 0.001^a
mean (± SD)	66.9 (± 14.2)	71.3 (± 12.5)
18-44	171857 (5.7)	2337 (2.2)
45-64	1178621 (38.8)	28567 (27.2)
65-84	1288783 (42.4)	57054 (54.2)
≥ 85	400285 (13.2)	17240 (16.4)
Sex			< 0.001^a
Male	1830228 (60.2)	77834 (74.0)
Female	1209120 (39.8)	27355 (26.0)
Race			< 0.001^a
White	2102509 (75.4)	69431 (71.8)
African American	302121 (10.8)	14798 (15.3)
Hispanic	218605 (7.8)	4833 (5.0)
Asian and Pacific Islander	61156 (2.2)	4799 (5.0)
Native American	16624 (0.6)	394 (0.4)
Others	88091 (3.2)	2477 (2.6)
Admission type			< 0.001
Non-elective	2847182 (93.9)	98886 (94.1)
Elective	185903 (6.1)	6149 (5.9)
Median household income percentile for patient's zip code¹			< 0.001^a
0-25^th	894564 (30.1)	29758 (28.8)
26-50^th	807784 (27.2)	26606 (25.8)
51-75^th	701363 (23.6)	24152 (23.4)
76-100^th	566069 (19.1)	22637 (21.9)
Primary expected payer			< 0.001^a
Medicare	1709250 (56.4)	72559 (69.1)
Medicaid	218428 (7.20)	4232 (4.0)
Private including HMO	803459 (26.5)	22757 (21.7)
Self-pay/no charge/others	301827 (10.0)	5433 (5.2)
Control/ownership of hospital			< 0.001^a
Government, nonfederal	305519 (10.1)	9697 (9.3)
Private, non-profit	2258936 (74.7)	81175 (77.4)
Private, invest-own	459942 (15.2)	13962 (13.3)
Bed size of hospital			0.157
Small	351544 (11.6)	12101 (11.5)
Medium	767625 (25.4)	26387 (25.2)
Large	1905229 (63.0)	66346 (63.3)
Location/teaching status			< 0.001^a
Rural	312292 (10.3)	10030 (9.6)
Urban non-teaching	1183544 (39.1)	37858 (36.1)
Urban teaching	1528562 (50.5)	56946 (54.3)
Region of hospital			< 0.001^a
Northeast	575864 (18.9)	19077 (18.1)
Midwest	705042 (23.2)	24946 (23.7)
South	1219352 (40.1)	39502 (37.5)
West	539288 (17.7)	21672 (20.6)

^aP < 0.05 indicates clinical significance. The bed size cutoff points are derived from https://http://www.hcup-us.ahrq.gov/db/vars/hosp_bedsize/nisnote.jsp.

¹Represents a quartile classiﬁcation of the estimated median household income of residents in the patient’s ZIP Code, derived from https://http://www.hcup-us.ahrq.gov/db/vars/zipinc_qrtl/nisnote.jsp. HMO: Health maintenance organization; SNF: Skilled nursing facility; ICF: Intermediate care facility.

Table 2 Comorbidities in acute coronary syndrome without vs with gout

Comorbidities	ACS + no gout	ACS + gout	P value
Alcohol abuse	95449 (3.1)	3768 (3.6)	< 0.001^a
Deficiency anemias	487126 (16.0)	28065 (26.7)	< 0.001^a
Rheumatoid arthritis/collagen vascular diseases	72214 (2.4)	3343 (3.2)	< 0.001^a
Congestive heart failure	24213 (0.8)	811 (0.8)	0.357
Chronic pulmonary disease	634046 (20.9)	22789 (21.7)	< 0.001^a
Coagulopathy	152932 (5.0)	7283 (6.9)	< 0.001^a
Diabetes, uncomplicated	911629 (30.0)	36556 (34.7)	< 0.001^a
Diabetes with chronic complications	200881 (6.6)	12597 (12.0)	< 0.001^a
Drug abuse	95449 (3.1)	1519 (1.4)	< 0.001^a
Hypertension	75189 (2.5)	87598 (83.3)	< 0.001^a
Hypothyroidism	2170519 (71.4)	15366 (14.6)	< 0.001^a
Liver disease	334044 (11.0)	2013 (1.9)	< 0.001^a
Fluid and electrolyte disorders	43749 (1.4)	26081 (24.8)	< 0.001^a
Other neurological disorders	636496 (20.9)	6138 (5.8)	< 0.001^a
Obesity	186097 (6.1)	23082 (21.9)	< 0.001^a
Peripheral vascular disorders	443723 (14.6)	16964 (16.1)	< 0.001^a
Renal failure	355484 (11.7)	47359 (45.0)	< 0.001^a
Valvular disease	568903 (18.7)	327 (0.3)	< 0.001^a
Dyslipidemia	7101 (0.2)	74674 (71.0)	< 0.001^a
Coronary atherosclerosis	1879620 (61.8)	89777 (85.3)	< 0.001^a
Previous history of MI	2500606 (82.3)	16972 (16.1)	< 0.001^a
Family history of CAD	359298 (11.8)	8442 (8.0)	< 0.001^a
Previous PCI	298852 (9.8)	18591 (17.7)	< 0.001^a
Previous CABG	439722 (14.5)	13165 (12.5)	< 0.001^a
Previous history of cardiac arrest	247161 (8.1)	405 (0.4)	0.786
Smoking	11543 (0.4)	34019 (32.3)	< 0.001^a
History of venous thromboembolism	1210142 (39.8)	3146 (3.0)	< 0.001^a
Chronic kidney disease	66017 (2.2)	47909 (45.5)	< 0.001^a
Dialysis status	576268 (19.0)	4388 (4.2)	< 0.001^a

^aP < 0.05 (bold value) indicates clinical significance. ACS: Acute coronary syndrome; MI: Myocardial infarction; CAD: Coronary artery disease; PCI: Percutaneous coronary intervention; CABG: Coronary artery bypass grafting.

Table 3 Revascularization rates and outcomes in acute coronary syndrome with vs without gout

Outcomes	ACS + no gout(n = 3039546)	ACS + gout(n = 105198)	P value
Revascularization
Thrombolysis	56694 (1.9)	1408 (1.3)	< 0.001^a
PCI	1369759 (45.1)	38301 (36.4)	< 0.001^a
CABG	245983 (8.1)	9657 (9.2)	< 0.001^a
All-cause in-hospital mortality	151213 (5.0)	4539 (4.3)	< 0.001^a
Disposition			< 0.001^a
Routine	1878724 (61.8)	59605 (56.7)
Transfer to short-term hospital	290145 (9.6)	10506 (10.0)
Other transfers (SNF, ICF, other)	367183 (12.1)	15586 (14.8)
Home Health Care	318501 (10.5)	14208 (13.5)
Against Medical Advice	30531 (1.0)	681 (0.6)
Length of stay (d) mean (± SD)	4.5 (± 5.2)	5.1 (± 5.0)	< 0.001^a
Hospital charges ($) mean (± SD)	71312.73 (± 85186.10)	72328.21 (± 86223.92)	< 0.001^a

^aP < 0.05 indicates clinical significance. ACS: Acute coronary syndrome; PCI: Percutaneous coronary intervention; CABG: Coronary artery bypass grafting; SNF: Skilled nursing facility; ICF: Intermediate care facility.

Table 4 Post-revascularization (percutaneous coronary intervention or coronary artery bypass grafting) complications in acute coronary syndrome patients with vs without gout

Complications	No gout(n = 1592156)	Gout(n = 47307)	P value
All-cause in-hospital mortality	47466 (3.0)	1038 (2.2)	< 0.001^a
Hemorrhage	43541 (2.7)	1470 (3.1)	< 0.001^a
Blood transfusion	12272 (0.8)	524 (1.1)	< 0.001^a
Hypotension/shock	7319 (0.5)	261 (0.6)	0.004^a
Cardiac complications	46511 (2.9)	1523 (3.2)	< 0.001^a
Postoperative myocardial infarction	27176 (1.7)	798 (1.7)	0.74
Stroke	3926 (0.2)	140 (0.3)	0.033^a
Respiratory complications	46531 (2.9)	1642 (3.5)	< 0.001^a
Gastrointestinal complications	25573 (1.6)	980 (2.1)	< 0.001^a
AKI requiring dialysis	7843 (0.5)	628 (1.3)	< 0.001^a
Urinary complications	4641 (0.3)	307 (0.6)	< 0.001^a
Post procedural infections	24473 (1.5)	687 (1.5)	0.139

^aP < 0.05 indicates clinical significance. ACS: Acute coronary syndrome; PCI: Percutaneous coronary intervention; CABG: Coronary artery bypass grafting; AKI: Acute kidney injury.

Table 5 Predictors of in-hospital mortality in acute coronary syndrome patients with gout undergoing revascularization

Predictor	Adjusted odds ratio	95%CI (LL-UL)	P value
Age in years at admission			< 0.001^a
45-64 vs 18-44	2.99	1.08-8.30	0.036^a
65-84 vs 18-44	5.72	2.04-16.01	0.001^a
≥ 85 vs 18-44	15.63	5.51-44.39	< 0.001^a
Male vs female	0.89	0.75-1.05	0.155
Race			< 0.001^a
African American vs white	1.09	0.88-1.35	0.413
Hispanic vs white	0.45	0.31-0.67	< 0.001^a
Asian vs white	0.65	0.45-0.94	0.022^a
Non-elective vs elective admission	2.00	1.44-2.79	< 0.001^a
Median household income quartile 0-25^thvs 76-100^th#	1.44	1.17-1.78	0.001^a
Comorbidities
Alcohol abuse	0.49	0.31-0.79	0.003^a
Rheumatoid arthritis/collagen vascular diseases	1.57	1.09-2.25	0.016^a
Congestive heart failure	5.91	3.54-9.86	0.000^a
Coagulopathy	1.29	1.05-1.58	0.014^a
Drug abuse	2.33	1.34-4.05	0.003^a
Fluid and electrolyte disorders	2.88	2.49-3.35	< 0.001^a
Other neurological disorders	1.72	1.33-2.23	< 0.001^a
Obesity	0.79	0.66-0.95	0.012^a
Peripheral vascular disorders	1.60	1.36-1.88	< 0.001^a
Renal failure	2.04	1.13-3.70	0.019^a
Valvular disease	8.15	3.87-17.15	< 0.001^a
Dyslipidemia	0.63	0.54-0.72	< 0.001^a
Outcomes/postoperative complications
Hypotension/shock	2.97	1.93-4.56	< 0.001^a
Cardiac complications	1.59	1.19-2.11	0.002^a
Postoperative myocardial infarction	2.53	1.74-3.68	< 0.001^a
Perioperative stroke	2.48	1.20-5.10	0.014^a
Respiratory complications	1.80	1.41-2.30	< 0.001^a
Postoperative acute kidney injury	1.48	1.26-1.74	< 0.001^a
Infections/septicemia	3.94	3.01-5.16	< 0.001^a

^aP < 0.05 indicates clinical significance. CI: Confidence interval; LL: Lower level; UL: Upper level, Multivariate regression model was adjusted for age, gender, race, admission type, median household income, payer status, hospital characteristics and all relevant comorbidities and prior medical history.

Citation: Desai R, Parekh T, Goyal H, Fong HK, Zalavadia D, Damarlapally N, Doshi R, Savani S, Kumar G, Sachdeva R. Impact of gout on in-hospital outcomes of acute coronary syndrome-related hospitalizations and revascularizations: Insights from the national inpatient sample. World J Cardiol 2019; 11(5): 137-148
URL: https://www.wjgnet.com/1949-8462/full/v11/i5/137.htm
DOI: https://dx.doi.org/10.4330/wjc.v11.i5.137