Acute Myocardial Infarction among Hospitalizations for Heat Stroke in the United States
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source
2.2. Study Population
2.3. Data Collection
2.4. Statistical Analysis
3. Results
3.1. Incidence of and Risk Factors for Acute Myocardial Infarction in Hospitalized Heat Stroke Patients
3.2. The Association of Acute Myocardial Infarction with In-Hospital Treatments, Complications, and Outcomes
3.3. Impact of Acute Myocardial Infarction on Resource Utilization
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Total | Acute Myocardial Infarction | No Acute Myocardial Infarction | p-Value | |
---|---|---|---|---|
Clinical characteristics | ||||
N (%) | 3372 | 225 (6.7) | 3147 (93.3) | |
Age (years) | 55 ± 22 | 62 ± 20 | 54 ± 22 | <0.001 |
<20 | 218 (6.5) | 4 (1.8) | 214 (6.8) | <0.001 |
20–39 | 654 (19.4) | 27 (12.0) | 627 (19.9) | |
40–59 | 1034 (30.7) | 69 (30.7) | 965 (30.7) | |
60–79 | 900 (26.7) | 65 (28.9) | 835 (26.6) | |
≥80 | 564 (16.7) | 60 (26.7) | 504 (16.0) | |
Sex | <0.001 | |||
Male | 2478 (73.5) | 135 (60.0) | 2343 (74.5) | |
Female | 894 (26.5%) | 90 (40.0) | 804 (25.5%) | |
Race | 0.67 | |||
Caucasian | 1883 (55.8) | 118 (52.4) | 1765 (56.1) | |
African American | 496 (14.7) | 33 (14.7) | 463 (14.7) | |
Hispanic | 428 (12.7) | 33 (14.7) | 395 (12.6) | |
Other | 565 (16.8) | 41 (18.2) | 524 (16.7) | |
Smoking | 604 (17.9) | 22 (9.8) | 582 (18.5) | 0.001 |
Alcohol drinking | 270 (8.0) | 13 (5.8) | 257 (8.2) | 0.20 |
Obesity | 233 (6.9) | 26 (11.6) | 207 (6.6) | 0.004 |
Diabetes Mellitus | 562 (16.7) | 56 (24.9) | 506 (16.1) | 0.001 |
Hypertension | 1255 (37.2) | 112 (49.8) | 1143 (36.3) | <0.001 |
Dyslipidemia | 495 (14.7) | 41 (18.2) | 454 (14.4) | 0.12 |
Hypothyroidism | 196 (5.8) | 7 (3.1) | 189 (6.0) | 0.07 |
Chronic kidney disease | 201 (6.0) | 24 (10.7) | 177 (5.6) | 0.002 |
Coronary artery disease | 389 (11.5) | 37 (16.4) | 352 (11.2) | 0.02 |
Congestive heart failure | 216 (6.4) | 23 (10.2) | 193 (6.1) | 0.02 |
Atrial flutter/fibrillation | 251 (7.4) | 22 (9.8) | 229 (7.3) | 0.17 |
Treatment | ||||
Invasive mechanical ventilation | 686 (20.3) | 94 (41.8) | 592 (18.8) | <0.001 |
Blood component transfusion | 169 (5.0) | 35 (15.6) | 134 (4.3) | <0.001 |
Renal replacement therapy | 75 (2.2) | 11 (4.9) | 64 (2.0) | 0.005 |
Coronary angiogram ± primary coronary intervention | 18 (0.5) | 18 (8.0%) | 0 (0) | N/A |
Complication and outcomes | ||||
Hyponatremia | 293 (8.7) | 14 (6.2) | 279 (8.9) | 0.17 |
Hypernatremia | 183 (5.4) | 16 (7.1) | 167 (5.3) | 0.25 |
Hypokalemia | 500 (14.8) | 32 (14.2) | 468 (14.9) | 0.79 |
Hyperkalemia | 134 (4.0) | 10 (4.4) | 124 (3.9) | 0.71 |
Hypocalcemia | 73 (2.2) | 3 (1.3) | 70 (2.2) | 0.38 |
Hypercalcemia | 37 (1.1) | 1 (0.4) | 36 (1.1) | 0.33 |
Rhabdomyolysis | 1049 (31.1) | 83 (36.9) | 966 (30.7) | 0.05 |
Metabolic acidosis | 472 (14.0) | 50 (22.2) | 422 (13.4) | <0.001 |
Metabolic alkalosis | 29 (0.9) | 4 (1.8) | 25 (0.8) | 0.12 |
Sepsis | 149 (4.4) | 29 (12.9) | 120 (3.8) | <0.001 |
Gastrointestinal bleeding | 54 (1.6) | 16 (7.1) | 38 (1.2) | <0.001 |
Ventricular arrhythmia/cardiac arrest | 95 (2.8) | 16 (7.1) | 79 (2.5) | 0.001 |
Renal failure | 1226 (36.4) | 103 (45.8) | 1123 (35.7) | 0.002 |
Respiratory failure | 550 (16.3) | 87 (38.7) | 463 (14.7) | <0.001 |
Circulatory failure | 393 (11.7) | 40 (17.8) | 353 (11.2) | 0.003 |
Liver failure | 196 (5.8) | 35 (15.6) | 161 (5.1) | <0.001 |
Neurological failure | 651 (19.3) | 68 (30.2) | 583 (18.5) | <0.001 |
Hematological failure | 449 (13.3) | 60 (26.7) | 389 (12.4) | <0.001 |
In-hospital mortality | 168 (5.0) | 35 (15.6) | 133 (4.2) | <0.001 |
Resource utilization | ||||
Length of hospital stay (days) | 4.3 ± 7.0 | 8.0 ± 13.4 | 4.0 ± 6.2 | <0.001 |
Hospitalization cost ($) | 35,335 ± 72,085 | 72,444 ± 117,246 | 32,757 ± 67,112 | <0.001 |
Variables | Univariable Analysis | Multivariable Analysis | ||
---|---|---|---|---|
Crude Odds Ratio (95% CI) | p-Value | Adjusted Odds Ratio (95% CI) | p-Value | |
Age (years) | ||||
<20 | 0.26 (0.09–0.72) | 0.01 | 0.27 (0.10–0.76) | 0.01 |
20–39 | 0.60 (0.38–0.95) | 0.03 | 0.70 (0.43–1.12) | 0.13 |
40–59 | 1 (reference) | 1 (reference) | ||
60–79 | 1.09 (0.77–1.55) | 0.64 | 0.91 (0.62–1.33) | 0.62 |
≥80 | 1.67 (1.16–2.39) | 0.006 | 1.35 (0.89–2.04) | 0.16 |
Male | 0.51 (0.39–0.68) | <0.001 | 0.58 (0.43–0.79) | <0.001 |
Race | ||||
Caucasian | 1 (reference) | 1 (reference) | ||
African American | 1.07 (0.72–1.59) | 0.75 | 0.98 (0.65–1.48) | 0.91 |
Hispanic | 1.25 (0.84–1.87) | 0.28 | 1.40 (0.92–2.12) | 0.12 |
Other | 1.17 (0.81–1.69) | 0.40 | 1.20 (0.82–1.73) | 0.37 |
Smoking | 0.48 (0.31–0.75) | 0.001 | 0.68 (0.41–1.10) | 0.10 |
Alcohol drinking | 0.69 (0.39–1.23) | 0.21 | 0.89 (0.49–1.62) | 0.70 |
Obesity | 1.86 (1.20–2.86) | 0.005 | 1.78 (1.13–2.80) | 0.01 |
Diabetes Mellitus | 1.73 (1.26–2.37) | 0.001 | 1.21 (0.85–1.72) | 0.28 |
Hypertension | 1.74 (1.33–2.28) | <0.001 | 1.28 (0.93–1.75) | 0.13 |
Dyslipidemia | 1.32 (0.93–1.88) | 0.12 | 1.07 (0.73–1.58) | 0.73 |
Hypothyroidism | 0.50 (0.23–1.08) | 0.08 | 0.33 (0.15–0.71) | 0.005 |
Chronic kidney disease | 2.00 (1.28–3.14) | 0.002 | 1.61 (1.01–2.56) | 0.04 |
Coronary artery disease | 1.56 (1.08–2.26) | 0.02 | 1.22 (0.81–1.82) | 0.35 |
Congestive heart failure | 1.74 (1.11–2.75) | 0.02 | 1.18 (0.71–1.95) | 0.52 |
Atrial flutter/fibrillation | 1.38 (0.87–2.19) | 0.17 | 0.95 (0.57–1.57) | 0.83 |
Univariable Analysis | Multivariable Analysis | |||
---|---|---|---|---|
Crude Odds Ratio (95% CI) | p-Value | Adjusted Odds Ratio * (95% CI) | p-Value | |
Treatments | ||||
Invasive mechanical ventilation | 3.10 (2.34–4.10) | <0.001 | 4.53 (3.29–6.24) | <0.001 |
Blood component transfusion | 4.14 (2.78–6.18) | <0.001 | 4.57 (2.97–7.04) | <0.001 |
Renal replacement therapy | 2.48 (1.29–4.77) | 0.007 | 2.32 (1.13–4.77) | 0.02 |
Complications and outcomes | ||||
Hyponatremia | 0.68 (0.39–1.19) | 0.18 | 0.68 (0.39–1.20) | 0.18 |
Hypernatremia | 1.37 (0.80–2.33) | 0.25 | 1.37 (0.80–2.36) | 0.26 |
Hypokalemia | 0.95 (0.65–1.40) | 0.79 | 0.96 (0.64–1.42) | 0.82 |
Hyperkalemia | 1.13 (0.59–2.19) | 0.71 | 1.11 (0.57–2.17) | 0.76 |
Hypocalcemia | 0.59 (0.19–1.90) | 0.38 | 0.64 (0.20–2.09) | 0.46 |
Hypercalcemia | 0.39 (0.05–2.83) | 0.39 | 0.58 (0.08–4.38) | 0.60 |
Rhabdomyolysis | 1.32 (0.99–1.75) | 0.05 | 1.87 (1.37–2.53) | <0.001 |
Metabolic acidosis | 1.85 (1.33–2.57) | <0.001 | 2.22 (1.57–3.15) | <0.001 |
Metabolic alkalosis | 2.26 (0.78–6.55) | 0.13 | 1.97 (0.65–5.92) | 0.23 |
Sepsis | 3.73 (2.43–5.74) | <0.001 | 3.31 (2.11–5.21) | <0.001 |
Gastrointestinal bleeding | 6.26 (3.44–11.42) | <0.001 | 10.95 (3.37–35.50) | <0.001 |
Ventricular arrhythmia/cardiac arrest | 2.97 (1.71–5.18) | <0.001 | 3.07 (1.71–5.48) | <0.001 |
Renal failure | 1.52 (1.16–2.00) | 0.003 | 1.85 (1.38–2.47) | <0.001 |
Respiratory failure | 3.66 (2.75–4.86) | <0.001 | 4.64 (3.39–6.35) | <0.001 |
Circulatory failure | 1.71 (1.20–2.45) | 0.003 | 1.79 (1.24–2.59) | 0.002 |
Liver failure | 3.42 (2.30–5.07) | <0.001 | 5.48 (3.50–8.59) | <0.001 |
Neurological failure | 1.91 (1.41–2.57) | <0.001 | 1.96 (1.45–2.67) | <0.001 |
Hematological failure | 2.58 (1.88–3.53) | <0.001 | 3.22 (2.28–4.55) | <0.001 |
In-hospital mortality | 4.17 (2.79–6.22) | <0.001 | 5.21 (3.37–8.06) | <0.001 |
Coefficient (95% CI) | p-value | Adjusted coefficient (95% CI) | p-value | |
Resource utilization | ||||
Length of hospital stay (days) | 3.9 (3.8–4.3) | <0.001 | 3.9 (3.0–4.8) | <0.001 |
Hospitalization cost ($) | 39,687 (29,832–49,541) | <0.001 | 41,321 (31,465–51,177) | <0.001 |
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Bathini, T.; Thongprayoon, C.; Chewcharat, A.; Petnak, T.; Cheungpasitporn, W.; Boonpheng, B.; Prasitlumkum, N.; Chokesuwattanaskul, R.; Vallabhajosyula, S.; Kaewput, W. Acute Myocardial Infarction among Hospitalizations for Heat Stroke in the United States. J. Clin. Med. 2020, 9, 1357. https://doi.org/10.3390/jcm9051357
Bathini T, Thongprayoon C, Chewcharat A, Petnak T, Cheungpasitporn W, Boonpheng B, Prasitlumkum N, Chokesuwattanaskul R, Vallabhajosyula S, Kaewput W. Acute Myocardial Infarction among Hospitalizations for Heat Stroke in the United States. Journal of Clinical Medicine. 2020; 9(5):1357. https://doi.org/10.3390/jcm9051357
Chicago/Turabian StyleBathini, Tarun, Charat Thongprayoon, Api Chewcharat, Tananchai Petnak, Wisit Cheungpasitporn, Boonphiphop Boonpheng, Narut Prasitlumkum, Ronpichai Chokesuwattanaskul, Saraschandra Vallabhajosyula, and Wisit Kaewput. 2020. "Acute Myocardial Infarction among Hospitalizations for Heat Stroke in the United States" Journal of Clinical Medicine 9, no. 5: 1357. https://doi.org/10.3390/jcm9051357