Admission Day and Outcomes in Myocardial Infarction With Cardiogenic Shock: A Nationwide Propensity Score-Matched...

Area of Science:

• Cardiology
• Health Services Research
• Public Health

Background:

• The
• weekend effect
• in healthcare suggests disparities in outcomes based on hospital admission timing, with conflicting evidence in acute myocardial infarction (AMI) patients experiencing cardiogenic shock (CS).

Purpose of the Study:

• To investigate the impact of admission timing (weekday vs. weekend) on in-hospital mortality and other clinical outcomes for patients with ST-elevation myocardial infarction complicated by cardiogenic shock (STEMI-CS) and non-ST-elevation myocardial infarction complicated by cardiogenic shock (NSTEMI-CS).

Main Methods:

• Retrospective analysis of the Nationwide Inpatient Sample (2016-2021).
• Identification of STEMI-CS and NSTEMI-CS patients using ICD-10 codes.
• Propensity score matching and multivariable logistic regression to compare weekday versus weekend admissions, focusing on in-hospital mortality and secondary outcomes.

Main Results:

• In STEMI-CS patients, weekday admissions showed higher mortality (33.8%) than weekend admissions (32.2%, p=0.044), with less pacemaker implantation (0.4% vs. 0.8%, p=0.003).
• In NSTEMI-CS patients, weekend admissions had higher mortality (31.3%) compared to weekday admissions (28.9%, p=0.011).
• Other outcomes like PCI, stroke, and device implantation were comparable between weekday and weekend admissions in both cohorts.

Conclusions:

• Admission timing significantly influences in-hospital mortality in CS patients post-AMI, with divergent trends between STEMI-CS and NSTEMI-CS.
• Observed differences may stem from variations in hospital protocols, staffing, or resource allocation.
• Further research is needed to understand mechanisms and optimize care delivery irrespective of admission timing.