Cardiovascular outcomes in African American patients with multiple myeloma: The role of amyloidosis.

Abstract

e19566 Background: Amyloidosis, particularly light-chain (AL) amyloidosis, is a rare but serious complication of multiple myeloma (MM) that can significantly impact cardiac function, particularly among vulnerable populations. African Americans have a higher prevalence of multiple myeloma compared to other racial groups, yet the interplay between AL amyloidosis and cardiac outcomes in this population remains underexplored. This study aims to evaluate the association between AL amyloidosis and cardiac outcomes in African American patients with MM, providing insights into disease burden and guiding future management strategies. Methods: We analyzed data from the National Inpatient Sample (2018–2021) to identify Black adult patients admitted with a primary diagnosis of MM. Patients were stratified based on the presence or absence of AL amyloidosis, and comparisons were made between these two groups. Complex sampling weights were applied to ensure national representativeness. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included acute myocardial infarction (AMI), stroke, heart failure (HF), cardiogenic shock, and atrial fibrillation (AF). Results: Among 18,185 Black patients hospitalized with multiple MM, 180 (0.98%) had concomitant AL amyloidosis. MM patients with AL amyloidosis were predominantly male (61.1%). AL amyloidosis was not significantly associated with in-hospital mortality (aOR: 0.53, 95% CI: 0.07–4.08, p = 0.55). However, MM patients with AL amyloidosis had significantly higher odds of developing HF (aOR: 3.64, 95% CI: 1.64–8.06, p = 0.001), cardiogenic shock (aOR: 11.09, 95% CI: 2.40–51.19, p = 0.002), and stroke (aOR: 8.05, 95% CI: 1.63–39.83, p = 0.01) compared to those without AL amyloidosis. No significant differences were observed between groups in the incidence of AMI or AF. Conclusions: Among African Americans with MM, AL amyloidosis was rare but significantly associated with an increased risk of HF, cardiogenic shock, and stroke. These findings highlight the cardiovascular burden of AL amyloidosis in this population and underscore the need for early detection and targeted management strategies to mitigate adverse outcomes.