Saraschandra Vallabhajosyula1,2,3, Shannon M Dunlay1,4, Malcolm R Bell1, P Elliott Miller5, Wisit Cheungpasitporn6, Pranathi R Sundaragiri7, Kianoush Kashani2,8, Bernard J Gersh1, Allan S Jaffe1, David R Holmes1, Gregory W Barsness1. 1. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA. 2. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA. 3. Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN 55905, USA. 4. Department of Health Science Research, Mayo Clinic, Rochester, MN 55905, USA. 5. Division of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT 06511, USA. 6. Division of Nephrology, Department of Medicine, University of Mississippi School of Medicine, Jackson, MS 39216, USA. 7. Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA. 8. Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Abstract
BACKGROUND: There are limited data on the epidemiology and timing of in-hospital death (IHD) in patients with acute myocardial infarction-cardiogenic shock (AMI-CS). METHODS: Adult admissions with AMI-CS with IHDs were identified using the National Inpatient Sample (2000-2016) and were classified as early (≤2 days), mid-term (3-7 days), and late (>7 days). Inter-hospital transfers and those with do-not-resuscitate statuses were excluded. The outcomes of interest included the epidemiology, temporal trends and predictors for IHD timing. RESULTS: IHD was noted in 113,349 AMI-CS admissions (median time to IHD 3 (interquartile range 1-7) days), with early, mid-term and late IHD in 44%, 32% and 24%, respectively. Compared to the mid-term and late groups, the early IHD group had higher rates of ST-segment-elevation AMI-CS (74%, 63%, 60%) and cardiac arrest (37%, 33%, 29%), but lower rates of acute organ failure (68%, 79%, 89%), use of coronary angiography (45%, 56%, 67%), percutaneous coronary intervention (33%, 36%, 42%), and mechanical circulatory support (31%, 39%, 50%) (all p < 0.001). There was a temporal increase in the early (adjusted odds ratio (aOR) for 2016 vs. 2000 2.50 (95% confidence interval (CI) 2.22-2.78)) and a decrease in mid-term (aOR 0.75 (95% CI 0.71-0.79)) and late (aOR 0.34 (95% CI 0.31-0.37)) IHD. ST-segment-elevation AMI-CS and cardiac arrest were associated with the increased risk of early IHD, whereas advanced comorbidity and acute organ failure were associated with late IHD. CONCLUSIONS: Early IHD after AMI-CS has increased between 2000 and 2016. The populations with early vs. late IHD were systematically different.
BACKGROUND: There are limited data on the epidemiology and timing of in-hospital death (IHD) in patients with acute myocardial infarction-cardiogenic shock (AMI-CS). METHODS: Adult admissions with AMI-CS with IHDs were identified using the National Inpatient Sample (2000-2016) and were classified as early (≤2 days), mid-term (3-7 days), and late (>7 days). Inter-hospital transfers and those with do-not-resuscitate statuses were excluded. The outcomes of interest included the epidemiology, temporal trends and predictors for IHD timing. RESULTS: IHD was noted in 113,349 AMI-CS admissions (median time to IHD 3 (interquartile range 1-7) days), with early, mid-term and late IHD in 44%, 32% and 24%, respectively. Compared to the mid-term and late groups, the early IHD group had higher rates of ST-segment-elevation AMI-CS (74%, 63%, 60%) and cardiac arrest (37%, 33%, 29%), but lower rates of acute organ failure (68%, 79%, 89%), use of coronary angiography (45%, 56%, 67%), percutaneous coronary intervention (33%, 36%, 42%), and mechanical circulatory support (31%, 39%, 50%) (all p < 0.001). There was a temporal increase in the early (adjusted odds ratio (aOR) for 2016 vs. 2000 2.50 (95% confidence interval (CI) 2.22-2.78)) and a decrease in mid-term (aOR 0.75 (95% CI 0.71-0.79)) and late (aOR 0.34 (95% CI 0.31-0.37)) IHD. ST-segment-elevation AMI-CS and cardiac arrest were associated with the increased risk of early IHD, whereas advanced comorbidity and acute organ failure were associated with late IHD. CONCLUSIONS: Early IHD after AMI-CS has increased between 2000 and 2016. The populations with early vs. late IHD were systematically different.
Entities:
Keywords:
acute myocardial infarction; cardiac intensive care unit; cardiogenic shock; critical care cardiology; in-hospital death; outcomes research
Authors: Saraschandra Vallabhajosyula; Jacob C Jentzer; Abhiram Prasad; Lindsey R Sangaralingham; Kianoush Kashani; Nilay D Shah; Shannon M Dunlay Journal: ESC Heart Fail Date: 2021-04-09