Impact of amyloidosis on the outcomes of patients with coronary artery disease: A nationwide analysis

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Abstract
Background: Amyloidosis is a disease of increasing interest, primarily due to its high prevalence and advances in diagnostic and therapeutic options. It is known to be coexistent with a significant number of aortic stenosis patients (AS). Various studies have been done to evaluate its role in the clinical outcomes of AS. However, there is a lack of similar data on coronary artery disease (CAD) patients. Methods: We conducted a cross-sectional cohort study using the nationwide inpatient sample (NIS) 2018–19. We included 305,675 adult inpatients with CAD and further divided by the presence of a co-diagnosis of amyloidosis. A logistic regression model was used to evaluate the odds ratio (OR) of the association between in-hospital mortality in CAD inpatients with and without amyloidosis and other comorbidities. Results: The prevalence of amyloidosis in the total inpatient population with CAD was 7.3%, with the majority of the patients being in the older age group (mean age: 66.88 years), males (64.2%), and white (70.9%). Interestingly, the amyloidosis cohort had a higher prevalence of hypertension (89.3% vs. 85.1%). CAD inpatients with amyloidosis were noted to have higher in-hospital mortality (1.6% vs. 0.9%) with an OR of 1.87 (95% CI 1.66–2.11, p <0.001). These patients also had a higher length of stay (6.66 days vs. 4.68 days), total charges ($156,149.76 vs. $119,442.71), and major loss of function (56.5% vs. 30.5%). Amongst patients with CAD and amyloidosis, household income below the 50th percentile was a risk factor for in-hospital mortality (OR 1.5, 95% CI 1.39–1.63, p <0.001). Conclusions: Results from our study show that CAD inpatients who have comorbid amyloidosis have worse outcomes compared to those who do not. Further studies are needed to determine the etiology behind these outcomes and thus guide the management of stable CAD in amyloidosis patients.

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