The impact of liver disease on treatment and in-hospital outcomes in patients with acute myocardial infarction. Insights from the nationwide AMIS Plus registry

Abstract

Despite their higher risk of complications, there are currently no specific guideline recommendations for acute myocardial infarction (AMI) patients with liver disease. The aim of this analysis was to investigate the association of liver disease with treatment modalities and outcomes for patients with AMI in Switzerland. We included patients who had been enrolled in the Acute Myocardial Infarction in Switzerland (AMIS) Plus registry between 2003 and 2023. We compared patients with no liver disease (NLD), mild liver disease (MLD) and moderate to severe liver disease (MSLD), as defined by the Charlson Comorbidity Index. Descriptive and multivariable-adjusted logistic regression analyses were conducted. In addition, temporal trends in treatment and outcomes across predefined observation periods (2003-2009 vs. 2010-2016 vs. 2017-2023) were evaluated. Treatment modalities included the use of percutaneous coronary intervention (PCI) and dual antiplatelet therapy (DAPT), while outcomes encompassed the occurrence of in-hospital bleeding and in-hospital mortality. A total of 54,263 patients with AMI were included in this study, 386 of which presented with MLD (0.7%) and 335 with MSLD (0.6%). Patients with liver disease were less likely to receive PCI (NLD 82.8%, MLD 72.8%, MSLD 68.8%, p<0.001) and DAPT (NLD 84.2%, MLD 75.9%, MSLD 70.9%, p<0.001), and had higher crude event rates (bleeding: NLD 3.0%, MLD 3.4%, MSLD 6.7%, p=0.002, in-hospital mortality: NLD 4.8%, MLD 7%, MSLD 11.6%). After multivariable adjustment, patients with MSLD had consistently lower rates of PCI (OR 0.55, 95% CI 0.31-1.03, p=0.048) or DAPT (OR 0.51, 95% CI 0.28-0.98, p=0.03) compared to patients with NLD. In-hospital mortality and bleeding were increased in patients with MSLD (mortality: OR 2.67, 95% CI 1.00-6.06, p=0.031, bleeding: OR 2.52, 95% CI 1.52-3.92, p<0.001), compared to patients with NLD, whereas no increase was observed among patients with MLD (mortality: OR 0.73, 95% CI 0.17-2.10, p=0.6, bleeding: OR 1.07, 95% CI 0.53-1.90, p=0.8). Over the observed time periods, there were no changes in bleeding rates (MLD p=0.834, MSLD p=0.154) or in-hospital mortality (MLD p=0.261, MSLD p=0.194). However, the use of PCI and DAPT significantly increased over time in patients with MSLD (PCI: 54.9% vs. 71.9% vs. 79.1%, p<0.001, DAPT: 56.4% vs. 79.1% vs. 77.8%, p<0.001). Patients presenting with AMI and MSLD were less likely to receive PCI and DAPT and showed higher rates of in-hospital mortality and bleeding than patients without liver disease. Despite an increase in PCI and DAPT over time in patients with MSLD, in-hospital mortality and bleeding were not affected.