Cardiogenic shock and cardiac arrest complicating ST-segment elevation myocardial infarction in the United States,
Saraschandra Vallabhajosyula1, Shannon M Dunlay2, Abhiram Prasad3
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States; Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota, United States; Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States.
Insights
Cardiogenic shock and cardiac arrest complicating ST-elevation myocardial infarction (STEMI) have increased. The combination of both conditions significantly raises in-hospital mortality and organ failure rates in STEMI patients.
Area of Science:
- Cardiology
- Critical Care Medicine
- Health Services Research
Background:
- Limited data exist on the outcomes of cardiogenic shock (CS) and cardiac arrest (CA) in ST-elevation myocardial infarction (STEMI).
- Understanding these outcomes is crucial for improving patient care and resource allocation.
Purpose of the Study:
- To analyze temporal trends and outcomes of STEMI admissions complicated by CS and/or CA.
- To compare in-hospital mortality, hospitalization costs, and utilization of palliative care and DNR status across different STEMI complication cohorts.
Main Methods:
- Retrospective analysis of adult STEMI admissions (2000-2017) from the National Inpatient Sample.
- Classification of STEMI admissions into four groups: CS+CA, CS only, CA only, and no CS/CA.
- Comparison of temporal trends, mortality, costs, DNR status, and palliative care referrals.
Main Results:
- STEMI admissions with CS, CA, or both significantly increased from 2000 to 2017.
- The CS+CA cohort exhibited higher rates of multiorgan failure (77.2%) compared to CS only (59.7%) and CA only (26.3%).
- In-hospital mortality was substantially higher in the CS+CA group (aOR 18.37) compared to other cohorts.
Conclusions:
- The combination of CS and CA in STEMI patients is associated with significantly higher rates of non-cardiac organ failure and in-hospital mortality.
- These findings highlight the critical impact of combined CS and CA on STEMI outcomes.
- Further research and clinical strategies are needed to address the high burden of these complex cases.
Background:
There are limited data on the outcomes of cardiogenic shock (CS) and cardiac arrest (CA) complicating ST-segment-elevation myocardial infarction (STEMI).
Methods:
Adult (>18 years) STEMI admissions were identified using the National Inpatient Sample (2000-2017) and classified as CS + CA, CS only, CA only and no CS/CA. Outcomes of interest included temporal trends, in-hospital mortality, hospitalization costs, use of do-not-resuscitate (DNR) status and palliative care referrals across the four cohorts.
Results:
Of the 4,320,117 STEMI admissions, CS, CA and both were noted in 5.8%, 6.2% and 2.7%, respectively. In 2017, compared to 2000, there was an increase in CA (adjusted odds ratio [aOR] 1.83 [95% confidence interval {CI} 1.79-1.86]), CS (aOR 3.92 [95% CI 3.84-4.01]) and both (aOR 4.09 [95% CI 3.94-4.24]) (all p < 0.001). The CS+CA (77.2%) cohort had higher rates of multiorgan failure than CS only (59.7%) and CA only (26.3%), p < 0.001. The CA only cohort had lower rates (64%) of coronary angiography compared to the other groups (>70%), p < 0.001. In-hospital mortality was higher in CS+CA compared to CS alone (adjusted OR 1.87 [95% CI 1.83-1.91]), CA alone (adjusted OR 1.99 [95% CI 1.95-2.03]) or neither (aOR 18.37 [95% CI 18.02-18.71]). The CS+CA cohort had higher use of palliative care and DNR status. The presence of CS, either alone or in combination with CA, was associated with higher hospitalization costs.
Conclusions:
The combination of CS and CA was associated with higher rates of non-cardiac organ failure and in-hospital mortality in STEMI compared to those with either CS or CA alone.
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