Saraschandra Vallabhajosyula1, Saarwaani Vallabhajosyula2, Shannon M Dunlay3, Sharonne N Hayes2, Patricia J M Best2, Jorge A Brenes-Salazar4, Amir Lerman2, Bernard J Gersh2, Allan S Jaffe5, Malcolm R Bell2, David R Holmes2, Gregory W Barsness2. 1. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN; Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN. Electronic address: vallabhajosyula.saraschandra@mayo.edu. 2. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN. 3. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN. 4. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Division of Geriatric Medicine and Gerontology, Department of Medicine, Mayo Clinic, Rochester, MN. 5. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Division of Clinical Core Laboratory Services, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
Abstract
OBJECTIVE: To evaluate outcomes by sex in older adults with cardiogenic shock complicating acute myocardial infarction (AMI-CS). MATERIALS AND METHODS: A retrospective cohort of older (≥75 years) AMI-CS admissions during January 1, 2000, to December 31, 2014, was identified using the National Inpatient Sample. Interhospital transfers were excluded. Use of angiography, percutaneous coronary intervention (PCI), mechanical circulatory support (MCS), and noncardiac interventions was identified. The primary outcome was in-hospital mortality stratified by sex, and secondary outcomes included temporal trends of prevalence, in-hospital mortality, use of cardiac and noncardiac interventions, hospitalization costs, and length of stay. RESULTS: In this 15-year period, there were 134,501 AMI-CS admissions 75 years or older, of whom 51.5% (n=69,220) were women. Women were on average older, were more often Hispanic or nonwhite race, and had lower comorbidity, acute organ failure, and concomitant cardiac arrest. Compared with older men (n=65,281), older women (n=69,220) had lower use of coronary angiography (55.4% [n=35,905] vs 49.2% [n=33,918]), PCI (36.3% [n=23,501] vs 34.4% [n=23,535]), MCS (34.3% [n=22,391] vs 27.2% [n=18,689]), mechanical ventilation, and hemodialysis (all P<.001). Female sex was an independent predictor of higher in-hospital mortality (adjusted odds ratio, 1.05; 95% CI, 1.02-1.08; P<.001) and more frequent discharges to a skilled nursing facility. In subgroup analyses of ethnicity, presence of cardiac arrest, and those receiving PCI and MCS, female sex remained an independent predictor of increased mortality. CONCLUSION: Female sex is an independent predictor of worse in-hospital outcomes in older adults with AMI-CS in the United States.
OBJECTIVE: To evaluate outcomes by sex in older adults with cardiogenic shock complicating acute myocardial infarction (AMI-CS). MATERIALS AND METHODS: A retrospective cohort of older (≥75 years) AMI-CS admissions during January 1, 2000, to December 31, 2014, was identified using the National Inpatient Sample. Interhospital transfers were excluded. Use of angiography, percutaneous coronary intervention (PCI), mechanical circulatory support (MCS), and noncardiac interventions was identified. The primary outcome was in-hospital mortality stratified by sex, and secondary outcomes included temporal trends of prevalence, in-hospital mortality, use of cardiac and noncardiac interventions, hospitalization costs, and length of stay. RESULTS: In this 15-year period, there were 134,501 AMI-CS admissions 75 years or older, of whom 51.5% (n=69,220) were women. Women were on average older, were more often Hispanic or nonwhite race, and had lower comorbidity, acute organ failure, and concomitant cardiac arrest. Compared with older men (n=65,281), older women (n=69,220) had lower use of coronary angiography (55.4% [n=35,905] vs 49.2% [n=33,918]), PCI (36.3% [n=23,501] vs 34.4% [n=23,535]), MCS (34.3% [n=22,391] vs 27.2% [n=18,689]), mechanical ventilation, and hemodialysis (all P<.001). Female sex was an independent predictor of higher in-hospital mortality (adjusted odds ratio, 1.05; 95% CI, 1.02-1.08; P<.001) and more frequent discharges to a skilled nursing facility. In subgroup analyses of ethnicity, presence of cardiac arrest, and those receiving PCI and MCS, female sex remained an independent predictor of increased mortality. CONCLUSION: Female sex is an independent predictor of worse in-hospital outcomes in older adults with AMI-CS in the United States.
Authors: Saraschandra Vallabhajosyula; Shannon M Dunlay; Gregory W Barsness; Charanjit S Rihal; David R Holmes; Abhiram Prasad Journal: Am J Cardiol Date: 2019-05-28 Impact factor: 2.778
Authors: Rohan Khera; Suveen Angraal; Tyler Couch; John W Welsh; Brahmajee K Nallamothu; Saket Girotra; Paul S Chan; Harlan M Krumholz Journal: JAMA Date: 2017-11-28 Impact factor: 56.272
Authors: Saraschandra Vallabhajosyula; Shilpkumar Arora; Ankit Sakhuja; Sopan Lahewala; Varun Kumar; Ghanshyam P S Shantha; Alexander C Egbe; John M Stulak; Bernard J Gersh; Rajiv Gulati; Charanjit S Rihal; Abhiram Prasad; Abhishek J Deshmukh Journal: Am J Cardiol Date: 2018-11-06 Impact factor: 2.778
Authors: Ajar Kochar; Hussein R Al-Khalidi; Steen M Hansen; Jay S Shavadia; Mayme L Roettig; Christopher B Fordyce; Shannon Doerfler; Bernard J Gersh; Timothy D Henry; Peter B Berger; James G Jollis; Christopher B Granger Journal: JACC Cardiovasc Interv Date: 2018-09-24 Impact factor: 11.195
Authors: Preciosa M Coloma; Vera E Valkhoff; Giampiero Mazzaglia; Malene Schou Nielsson; Lars Pedersen; Mariam Molokhia; Mees Mosseveld; Paolo Morabito; Martijn J Schuemie; Johan van der Lei; Miriam Sturkenboom; Gianluca Trifirò Journal: BMJ Open Date: 2013-06-20 Impact factor: 2.692
Authors: Thomas Pilgrim; Dik Heg; Kali Tal; Paul Erne; Dragana Radovanovic; Stephan Windecker; Peter Jüni Journal: PLoS One Date: 2015-09-09 Impact factor: 3.240
Authors: Saraschandra Vallabhajosyula; Shilpkumar Arora; Sopan Lahewala; Varun Kumar; Ghanshyam P S Shantha; Jacob C Jentzer; John M Stulak; Bernard J Gersh; Rajiv Gulati; Charanjit S Rihal; Abhiram Prasad; Abhishek J Deshmukh Journal: J Am Heart Assoc Date: 2018-11-20 Impact factor: 5.501
Authors: Saraschandra Vallabhajosyula; Abhiram Prasad; Shannon M Dunlay; Dennis H Murphree; Cory Ingram; Paul S Mueller; Bernard J Gersh; David R Holmes; Gregory W Barsness Journal: J Am Heart Assoc Date: 2019-07-18 Impact factor: 5.501
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; Vinayak Kumar; Pranathi R Sundaragiri; Wisit Cheungpasitporn; Malcolm R Bell; Mandeep Singh; Allan S Jaffe; Gregory W Barsness Journal: PLoS One Date: 2020-12-18 Impact factor: 3.240
Authors: Saraschandra Vallabhajosyula; Dhiran Verghese; Viral K Desai; Pranathi R Sundaragiri; Virginia M Miller Journal: Cardiovasc Res Date: 2022-02-21 Impact factor: 10.787