Abstract 2266: Ethnic Differences in Rate, Treatment and Outcome of Cardiogenic Shock Complicating ST Segment Elevation Myocardial Infarction - A Report From The National Registry Of Myocardial Infarction
Background Incidence of cardiogenic shock (CS) in minorities is not well studied. Guidelines recommend early revascularization for CS based on demonstrated benefit in the SHOCK trial -but ethnic differences in utilization and impact on mortality are unknown.
Objective To examine ethnic differences in rate, treatment and outcome of CS post-STEMI
Methods Prospective observational study of 305,343 non-transfer patients with STEMI admitted to PCI and CABG capable hospitals in NRMI. Rate of CS at presentation, in-hospital and total CS and CS mortality were compared among ethnic groups. Univariate and multivariate correlates of CS and mortality were analyzed.
Results Asians had higher rate of CS in all 3 categories compared to all other ethnic groups (Table⇓). Adjusted for known correlates of CS, OR (95% CI) of CS development in Asians vs Whites were - CS at presentation: 1.547 (1.309, 1.828), in-hospital: 1.403 (1.264, 1.558) and total: 1.432 (1.306, 1.571). Adjusted OR of total CS was 0.803 (0.755, 0.853) for Blacks and 1.020 (0.946, 1.099) for Hispanics vs Whites. Of all CS pts, lytic or mechanical reperfusion therapy was used less frequently in Blacks (50.1%) vs Whites (57.4%), Hispanics (54.8%) and Asians (57.4%), p<0.05. Total CS mortality was lower for Asians (51.8%) vs Whites (55.6%), Blacks (58.0%) and Hispanics (56.8%), p<0.05. Adjusted for known correlates of CS mortality, OR of mortality for total CS were - Blacks: 1.102 (0.969, 1.253); Hispanics: 1.144 (0.980, 1.336) and Asians: 0.956 (0.794, 1.150) vs Whites.
Conclusion In this large population of patients with STEMI enrolled in NRMI, Asians had increased likelihood of CS. Blacks were less likely to receive early reperfusion therapy. Adjusted risk of mortality was similar among ethnic groups. These findings may inform risk stratification and triage post-MI and warrant further investigation of ethnic differences in potential risk factors and pathophysiologic mechanisms of CS.