Saraschandra Vallabhajosyula1, Shannon M Dunlay2, Abhiram Prasad3, Kianoush Kashani4, Ankit Sakhuja5, Bernard J Gersh3, Allan S Jaffe3, David R Holmes3, Gregory W Barsness3. 1. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: Vallabhajosyula.Saraschandra@mayo.edu. 2. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Department of Health Science Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota. 3. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota. 4. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota; Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota. 5. Division of Cardiovascular Critical Care, Department of Cardiovascular and Thoracic Surgery, West Virginia University School of Medicine, Morgantown, West Virginia.
Abstract
BACKGROUND: There are limited data on acute noncardiac multiorgan failure in cardiogenic shock complicating acute myocardial infarction (AMI-CS). OBJECTIVES: The authors sought to evaluate the 15-year national trends, resource utilization, and outcomes of single and multiple noncardiac organ failures in AMI-CS. METHODS: This was a retrospective cohort study of AMI-CS using the National Inpatient Sample database from 2000 to 2014. Previously validated codes for respiratory, renal, hepatic, hematologic, and neurological failure were used to identify single or multiorgan (≥2 organ systems) noncardiac organ failure. Outcomes of interest were in-hospital mortality, temporal trends, and resource utilization. The effects of every additional organ failure on in-hospital mortality and resource utilization were assessed. RESULTS: In 444,253 AMI-CS admissions, noncardiac single or multiorgan failure was noted in 32.4% and 31.9%, respectively. Multiorgan failure was seen more commonly in admissions with non-ST-segment elevation AMI-CS, nonwhite race, and higher baseline comorbidity. There was a steady increase in the prevalence of single and multiorgan failure. Coronary angiography and revascularization were performed less commonly in multiorgan failure. Single-organ failure (odds ratio: 1.28; 95% confidence interval: 1.26 to 1.30) and multiorgan failure (odds ratio: 2.23; 95% confidence interval: 2.19 to 2.27) were independently associated with higher in-hospital mortality, greater resource utilization, and fewer discharges to home. There was a stepwise increase in in-hospital mortality and resource utilization with each additional organ failure. CONCLUSIONS: There has been a steady increase in the prevalence of multiorgan failure in AMI-CS. Presence of multiorgan failure was independently associated with higher in-hospital mortality and greater resource utilization.
BACKGROUND: There are limited data on acute noncardiac multiorgan failure in cardiogenic shock complicating acute myocardial infarction (AMI-CS). OBJECTIVES: The authors sought to evaluate the 15-year national trends, resource utilization, and outcomes of single and multiple noncardiac organ failures in AMI-CS. METHODS: This was a retrospective cohort study of AMI-CS using the National Inpatient Sample database from 2000 to 2014. Previously validated codes for respiratory, renal, hepatic, hematologic, and neurological failure were used to identify single or multiorgan (≥2 organ systems) noncardiac organ failure. Outcomes of interest were in-hospital mortality, temporal trends, and resource utilization. The effects of every additional organ failure on in-hospital mortality and resource utilization were assessed. RESULTS: In 444,253 AMI-CS admissions, noncardiac single or multiorgan failure was noted in 32.4% and 31.9%, respectively. Multiorgan failure was seen more commonly in admissions with non-ST-segment elevation AMI-CS, nonwhite race, and higher baseline comorbidity. There was a steady increase in the prevalence of single and multiorgan failure. Coronary angiography and revascularization were performed less commonly in multiorgan failure. Single-organ failure (odds ratio: 1.28; 95% confidence interval: 1.26 to 1.30) and multiorgan failure (odds ratio: 2.23; 95% confidence interval: 2.19 to 2.27) were independently associated with higher in-hospital mortality, greater resource utilization, and fewer discharges to home. There was a stepwise increase in in-hospital mortality and resource utilization with each additional organ failure. CONCLUSIONS: There has been a steady increase in the prevalence of multiorgan failure in AMI-CS. Presence of multiorgan failure was independently associated with higher in-hospital mortality and greater resource utilization.
Authors: Saraschandra Vallabhajosyula; Sri Harsha Patlolla; Shannon M Dunlay; Abhiram Prasad; Malcolm R Bell; Allan S Jaffe; Bernard J Gersh; Charanjit S Rihal; David R Holmes; Gregory W Barsness Journal: Circ Heart Fail Date: 2020-02-14 Impact factor: 8.790
Authors: Behnam N Tehrani; Alexander G Truesdell; Mitchell A Psotka; Carolyn Rosner; Ramesh Singh; Shashank S Sinha; Abdulla A Damluji; Wayne B Batchelor Journal: JACC Heart Fail Date: 2020-11 Impact factor: 12.035
Authors: Saraschandra Vallabhajosyula; Saarwaani Vallabhajosyula; Shannon M Dunlay; Sharonne N Hayes; Patricia J M Best; Jorge A Brenes-Salazar; Amir Lerman; Bernard J Gersh; Allan S Jaffe; Malcolm R Bell; David R Holmes; Gregory W Barsness Journal: Mayo Clin Proc Date: 2020-09 Impact factor: 7.616
Authors: Saraschandra Vallabhajosyula; Lina Ya'Qoub; Mandeep Singh; Malcolm R Bell; Rajiv Gulati; Wisit Cheungpasitporn; Pranathi R Sundaragiri; Virginia M Miller; Allan S Jaffe; Bernard J Gersh; David R Holmes; Gregory W Barsness Journal: Circ Heart Fail Date: 2020-09-29 Impact factor: 8.790
Authors: Saraschandra Vallabhajosyula; Sri Harsha Patlolla; Dhiran Verghese; Lina Ya'Qoub; Vinayak Kumar; Anna V Subramaniam; Wisit Cheungpasitporn; Pranathi R Sundaragiri; Peter A Noseworthy; Siva K Mulpuru; Malcolm R Bell; Bernard J Gersh; Abhishek J Deshmukh Journal: Am J Cardiol Date: 2020-04-06 Impact factor: 2.778
Authors: Saraschandra Vallabhajosyula; Abhiram Prasad; Malcolm R Bell; Gurpreet S Sandhu; Mackram F Eleid; Shannon M Dunlay; Gregory J Schears; John M Stulak; Mandeep Singh; Bernard J Gersh; Allan S Jaffe; David R Holmes; Charanjit S Rihal; Gregory W Barsness Journal: Circ Heart Fail Date: 2019-12-12 Impact factor: 8.790