Abstract 17004: Cardiogenic Shock Complicating Non-ST-Elevation Myocardial Infarction: Temporal Trends in the United States, 2003-2011
Background: Limited data are available on the contemporary and potentially changing trends in the incidence and outcomes of cardiogenic shock complicating non-ST-elevation myocardial infarction (NSTEMI).
Objectives: To examine temporal trends in the incidence of cardiogenic shock in patients with NSTEMI, as well as trends in coronary angiography, revascularization (PCI or CABG), and outcomes (in-hospital mortality and length of stay) in these patients.
Methods: We used the 2003-2011 Nationwide Inpatient Sample databases to identify all patients ≥18 years of age with a primary diagnosis of NSTEMI (ICD-9-CM code 410.71). Patients with a concomitant diagnosis of cardiogenic shock were identified using ICD-9-CM code 785.51. Temporal trends in incidence of cardiogenic shock, coronary angiography and revascularization rates, and outcomes were analyzed using logistic regression.
Results: From 2003 to 2011, among 3,628,071 patients with NSTEMI, 85,176 (2.3%) had cardiogenic shock. The proportion of NSTEMI patients who had cardiogenic shock documented increased from 1.8% in 2003 to 3.1% in 2011 (ptrend<0.001) (Fig 1A). In patients with NSTEMI and cardiogenic shock from 2003 to 2011, coronary angiography rates increased from 50.4% to 56.8% (ptrend<0.001), and revascularization rates increased from 38.3% to 50.7% (ptrend<0.001) (Fig 1B-C). There was a significant decline over time in in-hospital mortality in these patients [44.9% to 30.9%, adjusted OR (per year) 0.93, 95% CI 0.93-0.94, p=0.001] (Fig 1D). Median length of stay was 8 days (interquartile range 4-14 days). The proportion of patients with length of stay >8 days remained unchanged over the study period.
Conclusion: We observed an increasing incidence of cardiogenic shock in patients with NSTEMI together with an increase in coronary angiography and revascularization rates in these patients. Risk-adjusted in-hospital mortality decreased, and length of stay remained unchanged during the study period.
- Myocardial infarction, NSTEMI
- Shock, cardiogenic
- Percutaneous coronary intervention (PCI)
Author Disclosures: D. Kolte: None. S. Khera: None. K.S. Subramanian: None. C. Palaniswamy: None. M. Mujib: None. W.S. Aronow: None. R. Timmermans: None. D. Jain: None. S. Sule: None. A. Ahmed: None. W.H. Frishman: None. H.A. Cooper: None. D.L. Bhatt: None. G.C. Fonarow: None. J.A. Panza: None.
- © 2014 by American Heart Association, Inc.