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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Clinical profile, management and outcomes of patients with cardiogenic shock undergoing transfer between centers in
M Isabel Barrionuevo-Sánchez1, Albert Ariza-Solé1, Ana Viana-Tejedor2
1Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
Insights
Interhospital transfer for ST segment elevation myocardial infarction-related cardiogenic shock (STEMI-CS) is low but associated with better outcomes. Centers with higher STEMI-CS volume and cardiac intensive care units (CICU) improve survival.
Area of Science:
- Cardiology
- Critical Care Medicine
- Health Services Research
Background:
- ST segment elevation myocardial infarction-related cardiogenic shock (STEMI-CS) is a critical condition with high mortality.
- Interhospital transfer strategies for STEMI-CS patients are crucial for optimizing outcomes.
- Understanding the impact of hospital structure on STEMI-CS management is essential.
Purpose of the Study:
- To analyze the clinical profile, management, and prognosis of STEMI-CS patients requiring interhospital transfer.
- To evaluate the prognostic impact of structural variables within treating centers on STEMI-CS outcomes.
- To compare outcomes between patients managed at different types of revascularization-capable centers.
Main Methods:
- Retrospective analysis of 4189 STEMI-CS patients from 2016-2020 treated at revascularization-capable centers.
- Patients categorized into: (A) hospitals with interventional cardiology only, (B) hospitals with interventional cardiology and cardiac surgery, and (C) transferred to centers with both.
- Association of STEMI-CS volume, cardiac intensive care unit (CICU) availability, and heart transplant services with hospital mortality analyzed.
Main Results:
- Transferred patients (Group C) were younger, had higher cardiovascular risk, and received more revascularization and mechanical support.
- Crude mortality was significantly lower in transferred patients (46.2%) compared to non-transferred groups (60.3% in Group A, 54.4% in Group B).
- Higher STEMI-CS treatment volume and CICU availability were independently associated with lower hospital mortality (OR 0.75 and 0.80, respectively).
Conclusions:
- The proportion of STEMI-CS transfers is low, but these patients experience better outcomes.
- Transferred patients are younger and undergo more invasive interventions.
- Higher STEMI-CS case volume and CICU availability at receiving centers are linked to reduced mortality, highlighting the importance of specialized care.
Introduction And Objectives:
The aim of this study was to analyze the clinical profile, management, and prognosis of ST segment elevation myocardial infarction-related cardiogenic shock (STEMI-CS) requiring interhospital transfer, as well as the prognostic impact of structural variables of the treating centers in this setting.
Methods:
This study included patients with STEMI-CS treated at revascularization-capable centers from 2016 to 2020. The patients were divided into the following groups: group A: patients attended throughout their admission at hospitals with interventional cardiology without cardiac surgery; group B: patients treated at hospitals with interventional cardiology and cardiac surgery; and group C: patients transferred to centers with interventional cardiology and cardiac surgery. We analyzed the association between the volume of STEMI-CS cases treated, the availability of cardiac intensive care units (CICU), and heart transplant with hospital mortality.
Results:
A total of 4189 episodes were included: 1389 (33.2%) from group A, 2627 from group B (62.7%), and 173 from group C (4.1%). Transferred patients were younger, had a higher cardiovascular risk, and more commonly underwent revascularization, mechanical circulatory support, and heart transplant during hospitalization (P<.001). The crude mortality rate was lower in transferred patients (46.2% vs 60.3% in group A and 54.4% in group B, (P<.001)). Lower mortality was associated with a higher volume of care and CICU availability (OR, 0.75, P=.009; and 0.80, P=.047).
Conclusions:
The proportion of transfers in patients with STEMI-CS in our setting is low. Transferred patients were younger and underwent more invasive procedures. Mortality was lower among patients transferred to centers with a higher volume of STEMI-CS cases and CICU.
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