Abstract 309: Trends in LVAD Use and Outcomes Among Patients Admitted with Acute Myocardial Infarction

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Jennifer Lewey ◽  
Eric Secemsky ◽  
Charlotta Lindvall
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Mortality Rates ◽  
Left Ventricular ◽  
Mechanical Support ◽  
Icd9 Code ◽  
Baseline Characteristics ◽  
Support Devices ◽  
Over Time

Background: Mortality rates among patients with acute myocardial infarction (AMI) complicated by cardiogenic shock remain high. Implantation of left ventricular assist devices (LVAD) has become increasingly available since the approval of continuous flow devices in 2008 and in severe cases, may be used to prolong survival post AMI. Little is known about how the frequency of LVAD implantation and subsequent outcomes in AMI patients have changed over time. Methods: We used the National Inpatient Sample, a 20% stratified sample of all hospital discharges that uses scaled weights to approximate national estimates. We identified all patients with AMI (ICD9 code 410.1x) and LVAD implantation (ICD9 code 37.66) from 2006 through 2012.The primary outcome was in-hospital mortality. Baseline characteristics were compared over time using the chi-square test for categorical variables. Univariate logistic regression was used to examine the association between baseline characteristics and risk of mortality after LVAD. Results: The number of LVADs implanted for any indication increased from 713 to 2,960 during the study period whereas LVAD use among AMI patients remained stable (Figure). AMI patients who received an LVAD were predominately male and white and the average age was 56.3 years. The number of AMI patients receiving ECMO, Impella, or other short-term mechanical support devices as a bridge to LVAD increased over time whereas IABP use remained stable. Among patient and hospital factors studies, non-white race and later year of implantation were associated with lower mortality after LVAD. Use of other mechanical support devices was associated with higher mortality (OR 2.7, p=0.029). Post-LVAD mortality rates were higher for AMI compared to non-AMI patients but decreased for all patients over time: 57.1% to 21.2% for AMI patients (p <.0001) and 36.8% to 12.8% for patients without AMI, p < .0001). Conclusion: Among patients with AMI, LVAD use remains low and has not increased as has LVAD use for other indications. Although LVAD use in this population was initially associated with higher in-hospital mortality, our analysis suggests a narrowing of this gap. Future studies are needed to determine how long-term survival is affected and which patients are appropriate candidates for LVAD implantation after AMI.

Abstract 13052: Stability of Hospital Rankings for Acute Myocardial Infarction

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Saket Girotra ◽  
Gary Rosenthal ◽  
Xin Lu ◽  
Mary Vaughan-Sarrazin ◽  
Peter Cram
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Quality Improvement ◽  
Hospital Mortality ◽  
High Mortality ◽  
Marked Improvement ◽  
Mortality Rates ◽  
Composite Score ◽  
Baseline Performance ◽  
Over Time

Background: Although hospital mortality for acute myocardial infarction (AMI) varies widely, little is known regarding the trajectory of mortality over time at hospitals with high and low mortality at baseline. Methods: We studied 623,488 Medicare AMI patients at 1923 hospitals during 2007-2010. We used 30-day risk-standardized mortality rates (RSMR) to stratify hospitals as bottom 25% and top 25% in 2007 (baseline) and compared their performance on AMI mortality during next 3 years. We also ranked top 25% and bottom 25% hospitals into quartiles of RSMR, each year during 2008-2010 (0 = worst mortality quartile, to 3 = lowest mortality quartile), and summed quartile ranks for each year to yield a composite score (CS: range = 0 to 9). We examined which bottom 25% and top 25% hospitals achieved low ( < 1) and high CS (≤ 8). Results: Average RSMR in 2007 was 15.5% (range: 11.2%-21.6%). During 2008-2010, there was considerable overlap in AMI mortality at 481 hospitals that were top 25% (blue bars) and bottom 25% (red bars), respectively (Figure). Of bottom 25% hospitals, only 107 (22%) had persistently high mortality over next 3 years (CS < 1) where as 37 (8%) hospitals had marked improvement in AMI mortality (CS ≤ 8). Similarly, only 127 (26%) of top 25% hospitals had persistently low mortality over next 3 years (CS ≤ 8) and 37 (8%) had marked worsening in AMI mortality (CS < 1). Average RSMR at hospitals with persistently high mortality was 18.5% vs. 13.7% at hospitals with persistently low mortality, which led to an additional 834 Medicare deaths at high mortality hospitals. Patient and hospital characteristics were limited in differentiating hospitals with persistently high and persistently low mortality. Conclusions: Among hospitals with high and low mortality at baseline, performance on AMI mortality does not persist during subsequent years. Concentrating quality improvement efforts at a few hospitals with persistently high mortality could avoid a substantial number of AMI deaths.

scholarly journals Case Definitions for Acute Myocardial Infarction in Administrative Databases and Their Impact on In-Hospital Mortality Rates

2012 ◽  
Vol 48 (1) ◽  
pp. 290-318 ◽  
Author(s):  
Amy Metcalfe ◽  
Annabelle Neudam ◽  
Samantha Forde ◽  
Mingfu Liu ◽  
Saskia Drosler ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Mortality Rates ◽  
Administrative Databases ◽  
Case Definitions

scholarly journals Association between admission blood glucose and prognosis in non-diabetic patients with first-ever acute myocardial infarction

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Ramin Eskandari ◽  
Parisa Matini ◽  
Sepideh Emami ◽  
Yousef Rezaei
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Diabetic Patients ◽  
Ventricular Ejection Fraction ◽  
Cox Regression Analysis ◽  
Coronary Syndrome

Abstract Background: Admission hyperglycemia has been associated with major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with acute coronary syndrome. Methods: In this study we sought to determine the association between admission blood sugar (ABS) and the outcomes of non-diabetic patients with first-ever acute myocardial infarction (MI). Non-diabetic patients with MI were evaluated from March 2016 to March 2019. Baseline characteristics, laboratories, electrocardiogram, and baseline left ventricular ejection fraction (LVEF) were recorded. All patients were followed up and outcomes were obtained. Follow-up data comprised of repeating electrocardiogram and echocardiography at 1 year, and MACCE, including re-MI, stroke, and mortality. Results: A total of 312 patients with a mean age of 54.2 ± 11.9 years were evaluated. All patients were followed up for a median of 38 months. The frequencies of in-hospital mortality and MACCE at late follow-up were higher in third tertile of ABS compared with those in first and second tertiles (both p <0.05). Based on the Cox regression analysis, the independent predictors of MACCE included age (hazard ratio [HR] 1.068, 95% confidence interval [CI] 1.033 – 1.105, p <0.001), third tertile of ABS >172 mg/dL (HR 21.257, 95% CI 2.832 – 159.577, p=0.003), and baseline LVEF (HR 0.947, 95% CI 0.901 – 0.995, p=0.031). Conclusion: Admission stress hyperglycemia is associated with increased rates of in-hospital mortality and MACCE at late follow-up in non-diabetic patients with MI. Moreover, elevated ABS, older ages, and a decreased value of baseline LVEF predicted MACCE during follow-up.

scholarly journals Complete percutaneous myocardial revascularization in patients with STEMI complicated by cardiogenic shock

2019 ◽  
Vol 76 (2) ◽  
pp. 152-160
Author(s):  
Milovan Petrovic ◽  
Milana Jarakovic ◽  
Milenko Cankovic ◽  
Ilija Srdanovic ◽  
Mila Kovacevic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Myocardial Revascularization ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Vessel Disease ◽  
Early Revascularization ◽  
Infarct Related Artery

Background/Aim. Despite considerable progress in terms of early myocardial revascularization and the use of mechanical circulatory support, cardiogenic shock continues to be the leading cause of death in acute myocardial infarction. The current recommendations of the European Society of Cardiology advocate early revascularization of all critical stenosis or highly unstable lesions in the state of cardiogenic shock, while recently published studies favour the early revascularization of the infarct related artery only, in patients with acute myocardial infarction with the ST segment elevation (STEMI) presenting with cardiogenic shock. The aim of the study was to assess the impact of the complete early percutaneous myocardial revascularization in an acute myocardial infarction complicated by cardiogenic shock on intra- hospital mortality. Methods. The research was conducted as a retrospective observational analysis of data obtained from the hospital registry for cardiogenic shock. The study group consisted of 235 patients treated in the period from August 2007 until October 2016 for STEMI complicated by cardiogenic shock. Three groups were formed. The first group consisted of patients with one vessel disease who underwent revascularization of infarct related artery; the second group of patients had multi-vessel disease and only culprit lesions were revascularized and the third one consisted of patients with multi-vessel disease and the complete myocardial revascularization performed. Additional subgroups were formed in reference to the intra-aortic balloon pump (IABP) implantation. Intra-hospital mortality was analyzed in all groups and subgroups. Results. Revascularization of the culprit lesion alone among patients with multivessel disease was performed in 142 (60.4%) patients while the complete revascularization (revascularization of ?culprit? and other significant lesions) was performed in 28 (11.9%) patients with multi-vessel disease. There were 65 (27.7%) patients with single-vessel disease who underwent revascularization of infarct related artery. The lowest mortality was found in the group of patients with multi-vessel coronary disease who underwent complete myocardial revascularization and had IABP implanted (mortality was 35.7%). The difference in the mean value of the left ventricular ejection fraction (EF) between the surviving and deceased patients was statistically significant (p < 0.005). The average EF of survivors was 44% (35%?50%) while 30% (25%?39.5%) deceased of patients. Based on the obtained data, the mathematically predictive model was tested. The receiver operating characteristic (ROC) curve showed that our model is a good predictor of fatal outcome (p < 0.0005; AUROC = 0.766) with the sensitivity of 80.3%, and the specificity of 67%. Conclusion. STEMI complicated by cardiogenic shock is still associated with a high mortality rate. Complete myocardial revascularization independently as well as in combination with an IABP, significantly reduces mortality in patients with acute STEMI complicated by cardiogenic shock.

scholarly journals Outcomes of Hospitalizations for Cardiogenic Shock at Left Ventricular Assist Device Versus Non–Left Ventricular Assist Device Centers

2020 ◽  
Vol 9 (23) ◽  
Author(s):  
Joseph I. Wang ◽  
Daniel Y. Lu ◽  
MHS ◽  
Dmitriy N. Feldman ◽  
Stephen A. McCullough ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Left Ventricular ◽  
Assist Device ◽  
Ventricular Assist ◽  
Left Ventricular Assist

Background Cardiogenic shock (CS) is a complex syndrome associated with high morbidity and mortality. In recent years, many US hospitals have formed multidisciplinary shock teams capable of rapid diagnosis and triage. Because of preexisting collaborative systems of care, hospitals with left ventricular assist device (LVAD) programs may also represent “centers of excellence” for CS care. However, the outcomes of patients with CS at LVAD centers have not been previously evaluated. Methods and Results Patients with CS were identified in the 2012 to 2014 National Inpatient Sample. Clinical characteristics, revascularization rates, and use of mechanical circulatory support were analyzed in LVAD versus non‐LVAD centers. The association between hospital type and in‐hospital mortality was examined using multivariable logistic regression models. Of 272 075 hospitalizations, 26.0% were in LVAD centers. CS attributable to causes other than acute myocardial infarction represented most cases. In‐hospital mortality was lower in LVAD centers (38.9% versus 43.3%; P <0.001). In multivariable analysis, the odds of mortality remained significantly lower for hospitalizations in LVAD centers (odds ratio, 0.89; P <0.001). In patients with CS secondary to acute myocardial infarction, revascularization rates were similar between LVAD and non‐LVAD centers. The use of intra‐aortic balloon pump (18.7% versus 18.8%) and Impella/TandemHeart (2.6% versus 1.9%) was similar between hospital types, whereas extracorporeal membrane oxygenation was used more frequently in LVAD centers (4.3% versus 0.2%; P <0.001). Conclusions Risk‐adjusted mortality was lower in patients with CS who were hospitalized at LVAD centers. These centers likely represent specialized, shock team capable institutions across the country that may be best suited to manage patients with CS.

scholarly journals Cardiogenic shock without hypotension in acute myocardial infarction

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
R Caldeira Da Rocha ◽  
B Picarra ◽  
R Fernandes ◽  
F Dias Claudio ◽  
M Carrington ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Left Ventricular ◽  
Hospital Death ◽  
Lv Function ◽  
Vessel Occlusion ◽  
Funding Sources ◽  
Group 1

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiogenic Shock(CS)complicates 10%of Acute Myocardial Infarction(AMI), being the main cause for intra-hospital death in these patients.Although early revascularization has contributed to increase survival,mortality still presents high, being 40-50%.CS usually presents with inadequate cardiac output and persistent hypotension.However,after large AMI,peripheral hypoperfusion can occur with sustained or borderline systolic blood pressure(SBP). Purpose Characterize patients(pts)with CS after AMI in the absence of hypotension(defined as SBP &lt; 90mmHg),and assess impact in mortality. Methods We evaluated 528pts presenting with CS in context of AMI.We considered 2groups:Group 1-Pts who had SBP ≥90mmHg,without any inotropic drug or assist device and 2-Pts with SBP &lt; 90mmHg.We registered age,gender,co-morbidities,presentation,coronary anatomy and treatment strategies.We evaluated in-hospital mortality and complications:re-infarction,mechanical complications,high-grade atrioventricular block(AVB),sustained ventricular tachycardia,atrial fibrillation,resuscitated cardiac arrest and stroke. Results AMI presenting as Cardiogenic Shock without hypotension(CSWH)was found in 51%of pts(n = 272),of whom 69%were male.They were younger(between age of 45-64years old in 34%of cases vs 25%,p = 0.040)and had higher body mass index (27.3 ± 4.5vs 26 ± 4.1,p = 0.001).Hypertension was a similarly distributed comorbidity.In group 1,pts were previously more frequently under beta blocker medication (25.2%vs 17.7%,p = 0.047).In this group,mean left ventricular (LV)ejection fraction was 39 ± 13%,a quarter having severely depressed LV function(&lt;30%).Although STEMI was the most common presentation in both sets(73.5% vs 87.1%,p &lt; 0.001),NSTEMI was more prevalent in CSWH(23.9%vs12.1%,p &lt; 0.001).Those pts presented more,at admission,with dyspnea(14.9%vs5.5%,p &lt; 0.001)and in sinus rhythm(81.9%vs69%,p &lt; 0.001).In this group,ICU admission was less frequent(19.4%vs27.2%,p = 0.036),and only about half of pts were medicated with inotropic drugs(vs 78.1%,p &lt; 0.001).However,difference in intra-aortic balloon use wasn’t found.CSWH presented with multivessel disease in 63.8%of pts,being LAD more frequently the culprit vessel(42.4% vs 30.7%,p = 0.030),but fewer left main artery(LM)(4.2%vs14.0%,p = 0.003).Group 1 had fewer prevalence of vessel occlusion,which was particularly true for LM(3.8%vs11.5%,p = 0.015) and circumflex(12.4%vs20.7%,p = 0.047),and were less often submitted to revascularization.Group 1 had fewer AVB(9.8%vs22.4%,p &lt; 0.001).Rates of other complications were similar.In-hospital mortality was higher in classic CS(33.1% vs 43.8%, p= 0.012). Conclusion Cardiogenic Shock without hypotension was found in about half of pts with CS due to AMI.A majority of these were younger and globally had a less severe event and complications.Even though CSWH was associated with one third of in-hospital mortality,it was lower than in pts with hypotension.

Abstract 248: Mortality and Readmission After Acute Myocardial Infarction in the Department of Veterans Affairs Health Care System

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Paul L Hess ◽  
Elise C Gunzburger ◽  
Chuan-Fen Liu ◽  
Jacqueline Jones ◽  
Daniel D Matlock ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Veterans Affairs ◽  
Unplanned Readmission ◽  
Level Variation ◽  
Readmission Rates ◽  
Acute Mi ◽  
Over Time

Background: Little contemporary data about the performance of Veterans Affairs (VA) hospitals related to mortality and readmission rates after an acute myocardial infarction (MI) are available. Accordingly, we sought to characterize the rates of in-hospital and 30-day mortality and 30-day unplanned readmission after an acute MI as well as associated site-level variation. Methods: Using data from the External Peer Review Program, which abstracts data from the records of all patients admitted with an acute MI, linked with administrative data from the Corporate Data Warehouse, we performed an observational analysis of patients admitted with an acute MI from January 1, 2011, to February 28, 2014. Results: A total of 16,024 patients were admitted with an acute MI; 806 (5.0%) patients died during hospitalization, 1299 (8.1%) died within 30 days of admission, and 2529 (16.9%) had an unplanned hospital readmission. The annual risk-standardized in-hospital mortality rate (Hazard Ratio (HR) 0.90, 95% Credible Interval (CI) 0.83-0.98) and the 30-day mortality rate (HR 0.94, 95% CI 0.88-1.00) but not the unplanned readmission rate (HR 1.00, 95% CI 0.96-1.04) decreased over time ( Figure ). Individual hospital rates for in-hospital mortality, 30-day mortality, and 30-day unplanned readmission were comparable to the system-wide rates, with little variation between hospitals. Conclusions: In Veterans Affairs hospitals from 2011 to 2014, in-hospital and 30-day mortality but not 30-day unplanned readmissions rates declined over time. Little site-level variation in mortality or readmission rates was observed.

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