Limited evidence exists regarding the in-hospital outcomes of patients experiencing coronary artery dissection. Therefore, the objective of the present study was to determine the inpatient mortality rate and baseline characteristics of patients experiencing coronary artery dissection in the United States during a 10 year period.
The National (Nationwide) Inpatient Sample was queried between the years of 2003 and 2012 to identify patients with coronary artery dissection. The study population was identified using validated international Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9- CM) diagnosis and procedure codes. Categorical variables were compared using Chi Square, Wilcoxon signed rank test was used for continuous variables.
Overall, a total of 82,736 patients with coronary dissection were identified between the years of 2003 and 2012, of which 3144 (3.8%) experienced in-hospital death. Analysis of baseline characteristics revealed that patients who died were older (70 vs 62, P<0.001), more often female (53.1 vs 46.9, P=0.002), and had higher rates of ischemic heart disease (70.2% vs 46.5%, P<0.001), congestive heart disease (30.7% vs 13.7%, P<0.001), and chronic kidney disease (11.2 vs 6.6%, P<0.001). The rate of in-hospital mortality increased steadily from 3.6% in 2003 to 6% in 2012 (P<0.0001). This increase, coincided with significant increases in the proportion of females (39.5% in 2003 to 45.1% in 2012, P=0.003), and rates of ischemic heart disease (42% in 2003 to 61% in 2012, P<0.001), and chronic kidney disease (1.2% in 2003 to 10.7% in 2012, P<0.001) during the study period. No uniform trend in rates of coronary artery bypass grafting (P=0.23) or percutaneous coronary intervention (P=0.18) was observed in patients with coronary artery dissection.
Between the years of 2003 and 2012, the rate of in-hospital mortality has increased by 66% among patients experiencing coronary artery dissection in the United States.