Cardiogenic shock complicating non-ST-segment elevation myocardial infarction: An 18-year study

Area of Science:

• Cardiology
• Clinical Research
• Epidemiology

Background:

• Cardiogenic shock (CS) complicates non-ST-segment-elevation myocardial infarction (NSTEMI), leading to high mortality.
• Understanding the evolving epidemiology and outcomes of NSTEMI-CS is crucial for clinical practice and public health.
• Temporal trends in NSTEMI-CS management and outcomes in the United States remain incompletely characterized.

Purpose of the Study:

• To evaluate the epidemiology and outcomes of non-ST-segment-elevation myocardial infarction-cardiogenic shock (NSTEMI-CS) in the United States.
• To analyze temporal trends in NSTEMI-CS prevalence, management strategies, and in-hospital mortality.
• To assess changes in hospitalization costs and length of stay associated with NSTEMI-CS over time.

Main Methods:

• Retrospective analysis of adult NSTEMI-CS admissions from the National Inpatient Sample (2000-2017).
• NSTEMI-CS cases were identified and classified by admission year tertiles.
• Outcomes assessed included prevalence, in-hospital mortality, cardiac procedure utilization, costs, and length of stay.

Main Results:

• NSTEMI-CS prevalence increased from 1.5% to 3.6% between 2000 and 2017.
• In-hospital mortality for NSTEMI-CS decreased significantly from 50.2% to 32.3% during the study period.
• Utilization of coronary angiography, percutaneous coronary intervention, and mechanical circulatory support devices increased, while intra-aortic balloon pump use remained stable.

Conclusions:

• The prevalence of cardiogenic shock in NSTEMI patients has doubled in the US from 2000 to 2017.
• Despite increased prevalence, in-hospital mortality for NSTEMI-CS has significantly decreased, reflecting advancements in treatment.
• Increased use of coronary angiography and percutaneous coronary intervention correlates with improved survival in NSTEMI-CS.