Trauma associated with acute myocardial infarction in a multi-state hospitalized population.
BACKGROUND
Trauma has been suggested, in case series, as one of the nonatherosclerotic mechanisms leading to acute myocardial infarction (AMI), the leading cause of death in the US. AMI following non-penetrating injury has been shown to carry significant morbidity and mortality.


OBJECTIVE
To determine whether hospitalized injuries in a large multi state population are associated with increased risk of AMI during the initial hospital stay.


METHODS
Statewide injury hospital discharge data were collected from 19 states in 1997. Affected body regions of interest included thoracic, abdominal or pelvic, spine or back and blunt cardiac injury (BCI). The outcome of interest was AMI which was identified based on ICD-9-CM discharge diagnoses for the same visit. Unadjusted and adjusted multivariate logistic regression analyses were performed.


RESULTS
Independent of confounding factors and coronary arteriography (CA) status, BCI was associated with 2.6-fold increased risk for AMI in persons 46 years or older. When the diagnosis of AMI was confirmed by CA, BCI was associated with 8-fold risk elevation among patients 46 years and older and a 31-fold elevation among patients 45 years and younger. Abdominal or pelvic trauma, irrespective of confounding factors and CA status, was associated with a 65% increase in the risk of AMI among patients 45 years and younger and 93% increase in the risk of among patients 46 years and older. When the diagnosis of AMI was confirmed by CA, abdominal or pelvic trauma was associated with 6-fold risk elevation among patients 46 years and older.


CONCLUSIONS
Direct trauma to the heart, as characterized by a diagnosis of BCI, was observed to carry the greatest risk for AMI. Abdominal or pelvic trauma also increased the risk for AMI. Longitudinal studies are warranted to better understand the relationship between trauma and AMI.
Ismailov
Rovshan M
RM
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, P.O. Box 19122, Pittsburgh, PA 15213, USA. rovshani@yahoo.com
Ness
Roberta B
RB
Weiss
Harold B
HB
Lawrence
Bruce A
BA
Miller
Ted R
TR
D017677:Age Distribution; D000368:Aged; D015986:Confounding Factors, Epidemiologic; D017023:Coronary Angiography; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D011159:Population Surveillance; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D014481:United States; D014947:Wounds and Injuries / Q000150:complications / Q000453:epidemiology*