Sepsis Impacts Survival in Medicare Beneficiaries Presenting with Acute Myocardial Infarction - Abstract
Background: Aggressive measures to rapidly identify acute myocardial infarction (AMI) patients and shorten door-to-balloon (D2B) time risks missing the diagnosis of alternative and/or concomitant medical conditions, including sepsis. This may delay initiation of appropriate therapy, for diseases like sepsis which account for 13.5% of all hospital admissions. The purpose of this study is to identify the impact of sepsis in patients with acute myocardial infarction, as well as the timing of percutaneous coronary intervention on mortality. Methods: Retrospective analysis of 2018 and 2019 Centers for Medicare and Medicaid Services-linked data identified all Medicare beneficiaries (MBs) hospitalized for an AMI (STEMI, NSTEMI, or Type II). The key outcome variables were observed and predicted hospital morality rates, and the timing of PCI procedure. Results: In total 859,794 MBs were hospitalized with AMI Present on Admission (POA) with an observed mortality rate of 8.2%. Of these MBs, nearly 14% also had sepsis POA. When sepsis was POA, 20.9% of MBs died during their AMI hospitalization compared to 6.2% of MBs without sepsis POA. MBs with sepsis who had their PCI on the day of admission all experienced higher observed than predicted mortality rates regardless of the type of AMI with the difference between observed and predicted mortality rates ranging for 10.7 percentage points for Type II AMI to 6.63 percentage points for MBs with STEMI. Conversely MBs with sepsis who received a PCI after their admission day, all had observed mortality rates that were lower than predicted mortality rates. Conclusions: MBs with AMI who are septic on admission are 3.3 times more likely to die than those MBs without sepsis. A comparison of observed and predicted mortality rates among MBs with sepsis suggest that mortality rates for AMI patients with sepsis can be improved by delaying the timing of PCI.