Impact of Charlson Comorbidity Index Score on Management and Outcomes after Acute Coronary Syndrome

Abstract Patients presenting with acute coronary syndrome (ACS) are frequently comorbid. However, there is limited data on how comorbidity burden impacts their receipt of invasive management and subsequent outcomes. We analyzed all patients with a discharge diagnosis of ACS from the National Inpatient Sample (2004-2014), stratified by Charlson Comorbidity Index (CCI) into 4 classes (CCI 0, 1, 2 and ≥3). Regression analyses were performed to examine associations between comorbidity burden and receipt of invasive intervention and in-hospital clinical outcomes. Of all 6,613,623 ACS patients analyzed, the prevalence of patients with severe comorbidity (CCI≥3) increased from 10.8% (2004) to 18.1% (2014). CCI class negatively correlated with receipt of invasive management, with CCI≥3 group being the least likely to receive coronary angiography and PCI (odds ratio (OR): 0.42 95%CI 0.41-0.43 and OR 0.47, 95%CI 0.46-0.48, respectively). CCI class was independently associated with an increased risk of mortality and complications, especially CCI≥3 that was associated with significantly increased odds of MACCE (OR 1.70, 95%CI 1.66-1.75), mortality (OR 1.74, 95%CI 1.68-1.79), acute ischemic stroke (OR 2.35, 95%CI 2.23-2.46) and major bleeding (OR 1.64, 95%CI 1.59-1.69). Comorbidity burden has significantly increased amongst those presenting with ACS over an 11-year period and correlates with reduced likelihood of receipt of invasive management and increased odds of mortality and adverse outcomes. In conclusion, objective assessment of comorbidities using CCI score identifies high-risk ACS patients in whom targeted risk reduction strategies may reduce their inherent risk of mortality and complications.