Abstract 18012: Variability in the Utilization of Mechanical Circulatory Support in Cardiogenic Shock Complicating STEMI: Impact of Hospital PCI Volumes
Despite controversy about efficacy, mechanical circulatory support (MCS) is often utilized in patients with cardiogenic shock after ST elevation myocardial infarction (STEMI). We aimed to characterize the variability in MCS utilization in cardiogenic shock patients across hospitals in the US, according to annual volume of primary percutaneous interventions (PPCI).
Methods: We used the 2003-2011 Nationwide Inpatient Sample for the study. All admissions with principal diagnosis of STEMI, with an additional diagnosis of cardiogenic shock, were identified using ICD 9 diagnosis codes. MCS devices were identified using ICD-9 procedure codes. All hospitals were divided into quartiles based on annual PPCI volume.
Results: Of 372984 admissions with STEMI, we identified 32482 (8.5%) cases with cardiogenic shock during admission. Of these, MCS was utilized in 17415 (53.6%) patients. All hospitals treating cardiogenic shock patients were divided into quartiles such that quartiles 1-4 corresponded to hospitals performing <36, 37-68, 69-118 and ≥119 PPCIs annually. The number of cardiogenic shock patients treated in quartile 1, quartile 2, quartile 3 and quartile 4 hospitals were 1875, 4712, 8061 and 15853 patients respectively.
There was progressive increase in MCS utilization across hospital quartiles with increasing PPCI volume (Figure). MCS utilization in quartiles 1-4 hospitals was 44.9%, 55.2%, 57.6% and 58.5% respectively (p-trend<0.001). After adjustment for baseline, clinical and hospital characteristics (geographic location, teaching status, bed size), we still observed progressive increase in MCS utilization across the hospital quartiles (Figure).
Conclusion: There was significant variability in MCS utilization among STEMI patients with cardiogenic shock, based on annual PPCI volume of the treating hospital. Increase in annual PPCI volume was correlated with an increase in MCS utilization in STEMI patients complicated by cardiogenic shock.
Author Disclosures: S. Agarwal: None. K. Sud: None. J.M. Martin: None. V. Menon: None.
- © 2015 by American Heart Association, Inc.