Abstract 15114: Temporal Trends and Outcomes of Patients Undergoing Percutaneous Coronary Intervention for Cardiogenic Shock in the Setting of Acute Myocardial Infarction in the United States
Background: Multiple studies have reported a decline in mortality for patients with cardiogenic shock after acute myocardial infarction (CS-AMI), a finding which has been attributed to the increasing use of revascularization over the past decade. However, other recent studies that have focused specifically on patients with CS-AMI treated with early percutaneous coronary intervention (PCI) have paradoxically found no improvement in risk-adjusted mortality.
Hypothesis: To reconcile these discordances, we hypothesize that the clinical complexity of the PCI-population has changed over time, in ways not precisely adjusted for in previous studies. The objective of this study was to elucidate changes in the clinical characteristics of the CS-AMI population treated with PCI, and clarify its impact on mortality trends.
Methods: We conducted a retrospective analysis of the 2005-2012 Nationwide Inpatient Sample database. Patients with CS-AMI who underwent PCI within 24 hours of hospitalization were identified. Temporal trends in in-hospital mortality were analyzed.
Results: In an unadjusted analysis of 59,118 patients with CS-AMI, there was no significant change in in-hospital mortality (30% in 2005-2006 and 27.8% in 2011-2012, OR: 0.90; 95% CI: 0.79-1.01, p = .07). There was an increase in the proportion of patients with 3 or more Elixhauser comorbidities (28.5% vs. 51.5%) and comorbidity scores ≥5 (37.2% vs. 48.2%). The population of patients that suffered from cardiac arrest or needed intubation on the first hospital day increased from 27.8% to 42.6%. In a multivariate analysis, which adjusted for changes in early intubation or cardiac arrest as well as clinical comorbidities, mortality rates in 2011-2012 versus 2005-2006 decreased significantly (OR: 0.75; 95% CI: 0.65-0.85, p <.001)
Conclusions: During a period that corresponds to expanded PCI use and improved prehospital survival, risk-adjusted in-hospital mortality declined. Much of the survival benefit attributable to advances in the contemporary management of cardiogenic shock has been neutralized by an increase in the proportion of “extreme-risk” patients undergoing early PCI. This is likely responsible for the null effect on mortality at the population level over the past decade.
Author Disclosures: U. Krishnan: None. J. Brejt: None. J.S. Marcus: None. P. Goyal: None. R. Swaminathan: None. D. Feldman: Honoraria; Modest; Dr. Feldman has received consulting/speaker’s fees from Eli Lilly, Daiichi-Sankyo, Abbott Vascular, Pfizer, and Bristol-Myers Squibb.. S. Wong: None. R. Minutello: None. G. Bergman: None. H. Singh: None. L. Kim: None.
- © 2016 by American Heart Association, Inc.