NYMC Faculty Publications

Trends in Incidence, Management, and Outcomes of Cardiogenic Shock Complicating ST-Elevation Myocardial Infarction in the United States

Author Type(s)

Faculty

DOI

10.1161/JAHA.113.000590

Journal Title

Journal of the American Heart Association

First Page

000590

Last Page

000590

Document Type

Article

Publication Date

1-13-2014

Department

Medicine

Second Department

Pharmacology

Keywords

Age Factors, Aged, Aged, 80 and over, Chi-Square Distribution, Female, Hospital Costs, Hospital Mortality, Humans, Incidence, Intra-Aortic Balloon Pumping, Length of Stay, Logistic Models, Male, Middle Aged, Multivariate Analysis, Myocardial Infarction, Myocardial Revascularization, Odds Ratio, Practice Patterns, Physicians', Racial Groups, Retrospective Studies, Risk Factors, Sex Factors, Shock, Cardiogenic, Time Factors, Treatment Outcome, United States

Disciplines

Cardiology | Medicine and Health Sciences

Abstract

BACKGROUND: Limited information is available on the contemporary and potentially changing trends in the incidence, management, and outcomes of cardiogenic shock complicating ST-elevation myocardial infarction (STEMI).

METHODS AND RESULTS: We queried the 2003-2010 Nationwide Inpatient Sample databases to identify all patients ≥ 40 years of age with STEMI and cardiogenic shock. Overall and age-, sex-, and race/ethnicity-specific trends in incidence of cardiogenic shock, early mechanical revascularization, and intra-aortic balloon pump use, and inhospital mortality were analyzed. From 2003 to 2010, among 1 990 486 patients aged ≥ 40 years with STEMI, 157 892 (7.9%) had cardiogenic shock. The overall incidence rate of cardiogenic shock in patients with STEMI increased from 6.5% in 2003 to 10.1% in 2010 (P(trend)< 0.001). There was an increase in early mechanical revascularization (30.4% to 50.7%, P(trend)< 0.001) and intra-aortic balloon pump use (44.8% to 53.7%, P(trend)< 0.001) in these patients over the 8-year period. Inhospital mortality decreased significantly, from 44.6% to 33.8% (P(trend)< 0.001; adjusted OR, 0.71; 95% CI, 0.68 to 0.75), whereas the average total hospital cost increased from $35 892 to $45 625 (P(trend)< 0.001) during the study period. There was no change in the average length of stay (P(trend)=0.394). These temporal trends were similar in patients < 75 and ≥ 75 years of age, men and women, and across each racial/ethnic group.

CONCLUSIONS: The incidence of cardiogenic shock complicating STEMI has increased during the past 8 years together with increased use of early mechanical revascularization and intra-aortic balloon pumps. There has been a concomitant decrease in risk-adjusted inhospital mortality, but an increase in total hospital costs during this period.

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