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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
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The Impact of Atrial Fibrillation on In-Hospital Outcomes in Patients With Acute Myocardial Infarction Complicated by

Gupta Sonu1,2, Desai Rupak3,2, Hanna Bishoy1

  • 1Division of Cardiology, Morehouse School of Medicine, Atlanta, GA, USA.

Journal of Atrial Fibrillation
|May 22, 2020
PubMed

Insights

Atrial fibrillation (AF) did not increase mortality in acute myocardial infarction with cardiogenic shock (AMI-CS) patients receiving Impella® support. However, AF patients incurred higher healthcare costs and resource utilization.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Critical Care Medicine

Background:

  • Atrial fibrillation (AF) is a common comorbidity in patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS).
  • Percutaneous ventricular assist devices (pVADs), such as Impella®, are frequently used in AMI-CS patients undergoing percutaneous coronary interventions (PCI).
  • The impact of AF on clinical outcomes in this high-risk population is not fully understood.

Purpose of the Study:

  • To evaluate the effect of a concomitant diagnosis of atrial fibrillation (AF) on in-hospital clinical outcomes.
  • To compare healthcare resource consumption between patients with and without AF in the context of AMI-CS treated with pVAD support during PCI.

Main Methods:

  • A retrospective analysis of the National Inpatient Sample (2008-2014) database.
  • Identification of patients with AMI-CS requiring PCI with pVAD support, stratified by the presence (AF+) or absence (AF-) of AF.
  • Propensity-matched cohort analysis to compare in-hospital outcomes and resource utilization.

Main Results:

  • A total of 840 propensity-matched patients (420 AF+ vs. 420 AF-) were analyzed. Patients with AF were older.
  • All-cause in-hospital mortality rates were similar between groups (40.5% vs. 36.7%, p=0.245).
  • The AF+ group experienced higher postprocedural respiratory complications (9.5% vs. 4.8%, p=0.007), increased transfers to other facilities (27.3% vs. 17.8%, p<0.001), longer length of stay (11.9 vs. 9.1 days, p<0.001), and higher hospital charges ($308,478 vs. $277,982, p=0.008). In-hospital cardiac arrests were more frequent in the AF- group (32.0% vs. 19.2%, p<0.001).

Conclusions:

  • In patients with AMI-CS undergoing PCI with pVAD support, AF is not associated with increased in-hospital mortality.
  • Patients with AF demonstrate significantly greater healthcare resource consumption, including longer hospital stays and higher charges.
  • These findings highlight the importance of managing AF in AMI-CS patients to potentially mitigate resource utilization.
Abstract

Keywords:
Impellaacute myocardial infarctionarrhythmiaatrial fibrillationcardiogenic shockoutcomespercutaneous ventricular assist device (pVAD);

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