The impact of cardiac and noncardiac comorbidities on the short-term outcomes of patients hospitalized with acute myocardial infarction: a population-based perspective

Figures & data

Table 1 Characteristics of the study population according to number of noncardiac and cardiac comorbidities

Characteristic	Cardiac comorbidities						Noncardiac comorbidities
	0 (N = 382)	1 (N = 587)	2 (N = 7I8)	3 (N = 555)	≥4 (N = 730)	P-value	0 (N = 1,332)	1 (N = 95l)	2(N = 463)	≥3 (N = 226)	P-value
Age (mean, years)	59.8	65.5	73.0	74.3	76.2	<0.00l	66.5	73.0	75.8	77.3	<0.00l
Male (%)	72.5	58.3	51.4	52.4	49.3	<0.00l	62.3	52.6	44.1	46.5	<0.00l
White (%)	94.1	92.4	94.2	92.3	90.4	0.073	92.5	92.9	92.2	92.2	0.968
Married (%)	61.4	57.9	51.3	47.8	45.1	<0.00l	58.5	49.2	44.6	37.2	<0.00l
ST-segment myocardial infarction (%)	55.8	42.1	32.9	23.8	15.2	<0.00l	39.0	29.0	23.1	15.9	<0.00l
Initial myocardial infarction (%)	100.0	90.8	66.4	49.2	34.4	<0.00l	73.6	62.7	51.2	45.1	<0.00l
Serum cholesterol* (mean, mg/dL)	191.8	178.5	166.0	159.6	156.5	<0.00l	176.4	170.5	157.3	151.3	<0.00l
Serum glucose* (mean, mg/dL)	136.2	149.1	166.1	186.8	208.6	<0.00l	163.4	177.2	185.2	190.3	<0.00l
Estimated GFR* (mean, mL/min/1.73 m^2)	76.0	68.9	60.0	56.3	44.9	<0.00l	68.8	57.5	45.0	40.2	<0.00l
Systolic blood pressure* (mean, mmHg)	138.7	142.7	141.9	142.3	139.5	0.175	143.2	140.4	138.8	137.5	0.013
Diastolic blood pressure* (mean, mmHg)	81.0	80.5	76.5	74.7	71.1	<0.00l	79.6	75.0	71.7	70.5	<0.00l

Note:

* At hospital admission.

Abbreviation: GFR, glomerular filtration rate.

Figure 1 Prevalence of cardiac and noncardiac comorbidities.

Abbreviations: CHD, coronary heart disease; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; PVD, peripheral vascular disease.

Table 2 Receipt of cardiac medications and interventional procedures during hospitalization according to number of noncardiac and cardiac comorbidities

	Cardiac comorbidities						Noncardiac comorbidities
	0 (N = 382)	1 (N = 587)	2 (N = 7I8)	3 (N = 555)	≥4 (N = 730)	P-value	0 (N = 1,332)	1 (N = 95l)	2 (N = 463)	≥3 (N = 226)	P-value
Medication (%)
ACE-l/ARBs	68.1	75.1	70.6	75.5	74.4	0.031	74.9	71.9	70.0	72.6	0.156
Anticoagulants	82.5	84.5	83.1	83.6	82.7	0.908	83.6	84.2	82.5	79.6	0.387
Aspirin	97.1	96.3	93.9	91.5	92.6	<0.00l	96.1	93.2	91.6	90.3	<0.00l
Beta blockers	93.2	94.9	92.3	93.0	93.0	0.466	94.0	93.7	90.9	91.6	0.094
Lipid lowering	80.4	79.6	77.0	76.8	75.1	0.203	81.2	75.4	71.9	74.8	<0.00l
Thrombolytics	5.2	2.4	1.3	1.3	0.8	<0.00l	3.1	0.9	1.1	0.4	<0.00l
≥3 medications	93.2	92.7	91.1	91.7	92.2	0.733	93.4	91.3	90.1	91.6	0.085
≥4 medications	81.4	80.4	77.7	79.6	77.7	0.452	82.2	78.2	74.5	73.5	<0.00l
Procedures (%)
Percutaneous coronary intervention	69.6	61.8	46.4	39.6	27.3	<0.00l	60.6	41.4	29.2	19.9	<0.00l
CABG surgery	4.7	6.8	6.4	6.8	2.9	0.004	6.2	6.3	3.2	2.7	0.015

Abbreviations: ACE-I, angiotensin converting inhibitors; ARBs, angiotensin receptor blockers; CABG, coronary artery bypass grafting.

Table 3 Hospital CFRs and length of stay according to number of noncardiac and cardiac comorbidities

	Cardiac comorbidities						Noncardiac comorbidities
	0 (N = 382)	1 (N = 587)	2 (N = 718)	3 (N = 555)	≥ 4 (N = 730)	P for trend	0 (N = 1332)	1 (N = 951)	2 (N = 463)	≥3 (N = 226)	P for trend
Hospital CFR (%)	3.7	6.1	10.6	11.2	14.2	<0.00l	6.9	10.1	14.7	15.9	<0.00l
Length of stay
Mean (days)	4.2	4.7	5.3	5.6	6.5	<0.00l	4.7	5.6	6.4	6.8	<0.00l
>3 days (%)	39.8	48.0	55.7	60.8	68.1	<0.00l	47.8	58.3	68.6	70.7	<0.00l

Abbreviation: CFRs, case-fatality rates.

Table 4 Multivariable adjusted association† between frequency of noncardiac and cardiac comorbidities and hospital case-fatality (CF) and length of stay*

Variable	OR (95% CI)	OR (95% CI)	OR (95% CI)#
Hospital CF
Cardiac comorbidity
0	1.00		1.00
1	1.36 (0.69, 2.67)		1.31 (0.67, 2.57)
2	2.13 (1.12, 4.04)		2.00 (1.05, 3.82)
3	2.34 (1.20, 4.57)		2.14 (1.10, 4.20)
≥4	3.35 (1.73, 6.48)		2.80 (1.43, 5.49)
Noncardiac comorbidity
0		1.00	1.00
1		1.30 (0.94, 1.80)	1.20 (0.86, 1.67)
2		1.86 (1.29, 2.69)	1.63 (1.12, 2.37)
≥3		2.12 (1.36, 3.31)	1.76 (1.11, 2.78)
Variable	OR (95% CI)	OR (95% CI)	OR (95% CI)
Length of stay (>3 days)
Cardiac comorbidity
0	1.00		1.00
1	1.20 (0.90, 1.60)		1.16 (0.87, 1.55)
2	1.43 (1.07, 1.92)		1.36 (1.01, 1.83)
3	1.81 (1.31, 2.50)		1.65 (1.19, 2.29)
≥4	2.42 (1.74, 3.37)		2.03 (1.45, 2.86)
Noncardiac comorbidity
0		1.00	1.00
1		1.32 (1.10, 1.59)	1.24 (1.03, 1.50)
2		1.84 (1.44, 2.36)	1.64 (1.27, 2.11)
≥3		2.04 (1.46, 2.85)	1.73 (1.23, 2.44)

Notes:

* Adjusted for age, sex, race, marital status, year of hospitalization, and AMI order and type;

# adjusted for age, sex, race, marital status, year of hospitalization, AMI order and type, and the noncardiac and cardiac morbidities examined;

† the ORs for the first two table columns refer to the multivariable adjusted estimates when the cardiac comorbidities and noncardiac comorbidities are respectively analyzed separately, whereas the third column presents the adjusted estimates when both the cardiac and noncardiac comorbidities are included together in the model.

Abbreviations: AMI, acute myocardial infarction; CF, case-fatality; CI, confidence interval; OR, odds ratio.