Prevalence and clinical outcomes of acute myocardial infarction in patients presenting with major trauma

Riley J Batchelor; Joanna F Dipnall; David Read; Peter Cameron; Mark Fitzgerald; Dion Stub; Jeffrey Lefkovits

doi:10.1016/j.injury.2024.111996

Prevalence and clinical outcomes of acute myocardial infarction in patients presenting with major trauma

Injury. 2024 Oct 29:111996. doi: 10.1016/j.injury.2024.111996. Online ahead of print.

Authors

Riley J Batchelor¹, Joanna F Dipnall², David Read³, Peter Cameron⁴, Mark Fitzgerald⁴, Dion Stub⁵, Jeffrey Lefkovits⁶

Affiliations

¹ Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Cardiology, Alfred Health, Melbourne, Australia. Electronic address: riley.batchelor@mh.org.au.
² School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; School of Medicine, Deakin University, Geelong, Australia.
³ Trauma Service, Royal Melbourne Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
⁴ School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Emergency and Trauma Centre, Alfred Health, Melbourne, Australia.
⁵ Department of Cardiology, Alfred Health, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
⁶ Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.

PMID: 39516144
DOI: 10.1016/j.injury.2024.111996

Abstract

Background: The occurrence and sequelae of acute myocardial infarction (AMI) in major trauma patients is underexplored across both trauma and cardiology specialties. Coronary reperfusion greatly reduces the risk of significant morbidity and mortality in AMI. However, in patients presenting with significant injuries, concurrent AMI presents a competing management priority given the increase in risk of bleeding with standard anticoagulation and antiplatelet therapy, which may be contraindicated. This study aimed to evaluate the epidemiology and clinical outcomes associated with AMI in a contemporary major trauma cohort.

Methods: This study used data from the Victorian State Trauma Registry (VSTR). All adult patients with major trauma from 1 January 2013 to 31 December 2022 were included. Patients that died prior to hospital arrival were excluded. AMI was identified by ICD-10-AM diagnosis codes recorded against the first hospital admission. Clinical outcomes included in-hospital mortality, length of stay, and discharge destination.

Results: 28,928 patients were identified over the 10-year study period. AMI occurred in 401 patients (1.4 %). AMI patients were older, had more comorbidities and were more frequently on anticoagulation or antiplatelet therapy. Low impact fall was the most common trauma mechanism in AMI patients. Patients with AMI experienced longer hospital stays (12 [7-20] versus 7 [4-12] days, p < 0.001) and higher rates of in-hospital mortality (adjusted RR 1.45, 95 % CI 1.25-1.65).

Conclusion: AMI in the setting of major trauma occurs in an older, more comorbid, and vulnerable group of patients. AMI is associated with an increased risk of in-hospital mortality and prolonged hospital stay in the setting of major trauma, underscoring the importance of identifying and treating major trauma associated AMI in a timely and effective manner.

Keywords: Acute coronary syndrome; Cardiology; Motor vehicle trauma, falls; Outcomes; Trauma; Troponin.