TCT-554 Contemporary trends on the impact of short term circulatory support on length of stay in patients with ST elevation myocardial infarction complicated by cardiogenic shock

Cardiogenic shock (CS) due to acute ST-elevation myocardial infarction is a complex state of low cardiac output and hemodynamic instability that transmutes to hypoperfusion of various body tissues leading to multi-organ dysfunction and death. Mortality rates due to CS remain high despite many recent advances in treatment. In the management of CS, early revascularization is the mainstay of the treatment. The patient can be stabilized using fl uids, vasopressors or inotropes, mechanical circulatory support, and general intensive care techniques. Due to only few randomized trials on CS patients, there is lack of concrete evidence supporting various treatment modalities, except for revascularization. Thus, CS and its management is a topic with more controversies than conclusions regarding optimal treatment and management.

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Abstract 13861: Trends in Utilization of Mechanical Circulatory Assist Devices in Patients Presenting with ST Elevation Myocardial Infarction

Circulation ◽

10.1161/circ.130.suppl_2.13861 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Shikhar Agarwal ◽

Venu Menon

Keyword(s):

Myocardial Infarction ◽

Hospital Mortality ◽

Cardiogenic Shock ◽

St Elevation Myocardial Infarction ◽

Circulatory Support ◽

Hierarchical Regression ◽

Study Duration ◽

Circulatory Assist Devices ◽

St Elevation ◽

Small Decline

Despite significant controversy about the efficacy, mechanical circulatory support (MCS) is often utilized in patients with cardiogenic shock after ST elevation myocardial infarction (STEMI). We aimed to characterize the trends and outcomes following the use of MCS devices in patients presenting with STEMI. Methods: We used the 2003-2011 US Nationwide Inpatient Sample for this study. All admissions with a principal diagnosis of STEMI were identified using standard ICD codes. MCS devices included intra aortic balloon pump or Impella and were identified using ICD procedure codes. Results: Of a total of 372984 admissions with STEMI, we identified 35685 (9.3%) cases that required MCS. Over the study duration, there was a significant increase in the utilization of MCS from 7.6% in 2003 to 10.5% in 2011 (Panel A). This increase in the use of MCS was accompanied by a significant increase in the incidence of cardiogenic shock in the study population (Panel A). Despite an increase in the overall cardiogenic shock incidence, there was a significant increase in the relative utilization of MCS in cardiogenic shock (Panel B) during the study duration. Of all the cardiogenic shock cases, utilization of MCS increased from 48.6% in 2003 to 57.4% in 2009, followed by a small decline to 54.7% in 2011. Among patients with cardiogenic shock, in-hospital mortality rate was 31.5% in patients with MCS as compared to 42.4% in those treated without MCS (p<0.001). Using multivariable hierarchical regression modeling, we found a significant reduction in adjusted in-hospital mortality with MCS, among patients with cardiogenic shock [OR (95% CI): 0.82 (0.77-0.88), p<0.001]. Conclusions: Over the last decade, there has been a significant increase in the utilization of MCS in patients with STEMI. In contrast to the results of the IABP trial, the use of MCS was associated with a significant reduction in in-hospital mortality in this real world nationwide experience.

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Relationship between age and the impact of revascularization on mortality in patients with non-ST-elevation myocardial infarction

European Heart Journal ◽

10.1093/ehjci/ehaa946.1766 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

T Asano ◽

Y Mitsuhashi ◽

J Yamashita ◽

R Ito ◽

M Saji ◽

...

Keyword(s):

Myocardial Infarction ◽

Medical Treatment ◽

Coronary Revascularization ◽

The Elderly ◽

St Elevation Myocardial Infarction ◽

Hospital Death ◽

Short Term ◽

Short Term Mortality ◽

St Elevation ◽

The Impact

Abstract Background It is known that the early coronary revascularization in patients with non-ST-elevation myocardial infarction (NSTEMI) was associated with favorable clinical outcomes. However, it is still unclear whether this efficacy is equivalent over all the ages of the patients. Methods Patients with NSTEMI were screened from the database of the Tokyo CCU network registry. Of those, the patients treated without revascularization (medical treatment) were matched with the patients receiving revascularization by propensity score matching. The probabilities of in-hospital death were calculated in the logistic regression model. In two subgroups stratified according to median of the age (elderly and non-elderly subgroups), the odds ratios of revascularization for in-hospital death were calculated. Results In the patients registered between 2013 and 2017, 4,851 patients with NSTEMI were identified. After the screening, 370 patients with medical treatment were matched with 370 patients treated with revascularization. The incidence of in-hospital death was significantly higher in the patients with medical treatment (20.3% vs 13.0%, P=0.01). The two probability curves of in-hospital death in patients with and without revascularization converged as age increased. In the elderly subgroup, the revascularization was not significantly associated with favorable outcome of mortality, whereas it had a significant impact on mortality in the non-elderly subgroup (odds ratio: 0.47 [95% CI 0.23–0.95]). Conclusion The impact of revascularization on short-term mortality in patients with NSTEMI tended to be reduced as age increased. Funding Acknowledgement Type of funding source: None

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Comparison of in-hospital outcomes and 30-days readmissions between type 1 and type 2 myocardial infarction patients: a study of the nationwide readmissions database

European Heart Journal ◽

10.1093/eurheartj/ehab724.1144 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

L Wu ◽

D D Song ◽

J A Daibes ◽

S Das ◽

M K Pena ◽

...

Keyword(s):

Myocardial Infarction ◽

Length Of Stay ◽

Early Mortality ◽

St Elevation Myocardial Infarction ◽

Index Admission ◽

Short Term ◽

Readmission Rates ◽

St Elevation

Abstract Introduction Traditionally Type- 1 myocardial infarction (T1-MI) results from a plaque erosion, rupture, or fissure. In contrast, Type- 2 myocardial infarction (T2-MI) is a consequence of severe supply and demand mismatch. Despite the different mechanisms, both T1-MI and T2-MI can be associated with severe morbidity and mortality. Yet there is sparse data analyzing in-hospital outcomes and readmission rates comparing patients who present with T1-MI and T2-MI. Purpose We aimed to compare the outcome data of patients with T1-MI and T2-MI derived from the Nationwide Readmissions Database, a large national database of hospital readmissions. Method We utilized the 2018 Nationwide Readmissions Database to identify all index hospital admissions with a primary diagnosis of “acute MI” (AMI) using ICD-10 diagnosis codes. All AMI admissions were further categorized into ST-elevation myocardial infarction (STEMI), no-ST-elevation myocardial infarction (NSTEMI), or T2-MI. Primary outcomes analyzed included 30-days major adverse cardiovascular events (MACE) (defined as re-infarction, repeat revascularization and death within 30 days of admission), short term mortality and readmission rates. Results Among 556,816 total admissions for AMI, 28,250 (5.1%) were T2-MI. Table 1 compares baseline variables and short-term outcomes for patients with T1-MI vs T2-MI. Compared to patients with T1-MI patients with T2-MI were older, more likely to be female, and had a higher burden of comorbidities. Additionally, T2-MI patients were less likely to receive coronary revascularization during the index admission. The mean length of stay for T2-MI patients was 4.7±0.6 days, which is longer than the length of stay for STEMI patient (4.1±0.4 days) but slightly shorter than NSTEMI patient (4.9±0.4 days). T2-MI patients had a higher rate of all-cause 30-days readmissions but a lower rate of 30-days MACE. Early mortality rate (within 30 days of index admission) in T2-MI patients was comparable to NSTEMI patients but was lower than STEMI patients. Cox proportional-hazards model adjusting for age, sex, comorbidities and type of hospital setting demonstrated that T2-MI was associated with a lower 30-day MACE risk (T2-MI vs STEMI: [HR 0.33 (95% CI 0.31–0.36)]; T2-MI vs NSTEMI [HR 0.70 (95% CI 0.64–0.75)]) and a lower risk of early mortality (T2-MI vs STEMI: [HR 0.29 (95% CI 0.26–0.32)]; T2-MI vs NSTEMI [HR 0.71 (95% CI 0.65–0.79)]). The adjusted HR for 30-days all-cause readmissions was higher with T2-MI, (T2-MI vs STEMI: [HR 1.16 (95% CI 1.10–1.23)]; T2-MI vs NSTEMI: [HR 1.11 (95% CI 1.06–1.16)]). Conclusion T2-MI patients are older and have a higher burden of comorbidities. After adjusting for baseline comorbidities, all-cause readmission risk is higher in T2-MI but short-term MACE and mortality is lower with T2-MI. FUNDunding Acknowledgement Type of funding sources: None.

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