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

• Published in: The American heart journal Vol. 244; pp. 54 - 65
• Main Authors: Vallabhajosyula, Saraschandra, Bhopalwala, Huzefa M., Sundaragiri, Pranathi R., Dewaswala, Nakeya, Cheungpasitporn, Wisit, Doshi, Rajkumar, Prasad, Abhiram, Sandhu, Gurpreet S., Jaffe, Allan S., Bell, Malcolm R., Holmes, David R.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2022; Elsevier Limited
• Subjects: Adult; Age; Angiography; Aorta; Comorbidity; Confidence intervals; Coronary artery; Demographics; Epidemiology; Extracorporeal membrane oxygenation; Heart; Heart attacks; Heart surgery; Hospital Mortality; Humans; Intra-Aortic Balloon Pumping - adverse effects; Intubation; Medical imaging; Mortality; Myocardial infarction; Non-ST Elevated Myocardial Infarction - complications; Non-ST Elevated Myocardial Infarction - diagnosis; Non-ST Elevated Myocardial Infarction - epidemiology; Oxygenation; Palliative care; Patients; Percutaneous Coronary Intervention - adverse effects; Population; Pulmonary arteries; Regression analysis; Segments; Shock, Cardiogenic - epidemiology; Shock, Cardiogenic - etiology; Shock, Cardiogenic - therapy; Socioeconomic factors; ST Elevation Myocardial Infarction - complications; ST Elevation Myocardial Infarction - epidemiology; ST Elevation Myocardial Infarction - therapy; Trends; United States - epidemiology; Veins & arteries; Ventricle; Ventricular assist devices; United States; United States > US; ECMO; NSTEMI; OR; IABP; CI; ICD-9CM; CS; pLVAD; HCUP; PCI; NIS; CABG; MCS; ICD-10CM
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2021.11.002

To evaluate the epidemiology and outcomes of non-ST-segment-elevation myocardial infarction-cardiogenic shock (NSTEMI-CS) in the United States. Adult (>18 years) NSTEMI-CS admissions were identified using the National Inpatient Sample (2000-2017) and classified by tertiles of admission year (2000-2005, 2006-2011 and 2012-2017). Outcomes of interest included temporal trends of prevalence and in-hospital mortality, use of cardiac procedures, in-hospital mortality, hospitalization costs, and length of stay. In over 7.3 million NSTEMI admissions, CS was noted in 189,155 (2.6%). NSTEMI-CS increased from 1.5% in 2000 to 3.6% in 2017 (adjusted odds ratio 2.03 [95% confidence interval 1.97-2.09]; P < .001). Rates of non-cardiac organ failure and cardiac arrest increased during the study period. Between 2000 and 2017, coronary angiography (43.9%-63.9%), early coronary angiography (13.6%-25.6%), percutaneous coronary intervention (14.8%-31.6%), and coronary artery bypass grafting use (19.0%-25.8%) increased (P < .001). Over the study period, the use of intra-aortic balloon pump remained stable (28.6%-28.8%), and both percutaneous left ventricular assist devices (0%-9.1%) and extra-corporeal membrane oxygenation (0.1%-1.6%) increased (all P < .001). In hospital mortality decreased from 50.2% in 2000 to 32.3% in 2017 (adjusted odds ratio 0.27 [95% confidence interval 0.25-0.29]; P < .001). During the 18-year period, hospital lengths of stay decreased, and hospitalization costs increased. In the United States, prevalence of CS in NSTEMI has increased 2-fold between 2000 and 2017, while in-hospital mortality has decreased during the study period. Use of coronary angiography and percutaneous coronary intervention increased during the study period.