Abstract 17446: Patient and Infarct Related Factors Predict the Need for Mechanical Ventilation in STEMI Patients
Introduction: Respiratory failure complicating acute coronary syndromes is common in clinical practice; however, predictors of the need for mechanical ventilation in STEMI patients have not been described.
Hypothesis: Patient co-morbidities and infarct-related clinical features predict need for mechanical ventilation (MV) in STEMI
Methods: We used the National Inpatient Sample to characterize the use of MV in adult patients with STEMI over a 12-year period. STEMI and MV were identified using ICD-9-CM codes. Patients transferred from another hospital were excluded. Logistic regression was performed to identify patient, hospital, and clinical characteristics associated with requiring MV within 24-hours of hospitalization. Multivariate models were adjusted for factors of a priori clinical interest including age, gender, race, Charlson comorbidity index, chronic lung disease, smoking, obesity, weekend admission, cardiac arrest, and cardiogenic shock.
Results: Of 1,867,114 STEMI patients included from 2002 to 2013, 72,220 were treated with mechanical ventilation (3.9%). Compared to STEMI patients requiring no respiratory support, patients who required MV were older (mean age 68 vs. 64 years), more likely to be female (40% vs. 34%), with more chronic lung disease (21% vs. 15%) and chronic kidney disease (13% vs. 7%) [p < 0.001 for all]. Patients requiring MV had higher rates of cardiogenic shock (46% vs. 6%) and in-hospital arrest (24% vs. 1%) and lower usage of PCI (50% vs. 63%) and CABG (5% vs. 7%) [p < 0.001 for all].
Older age (ORadj 1.04 [95% CI 1.02-1.06] per 10 years), female gender (ORadj 1.08 [95% CI 1.04-1.12]), increasing co-morbidity index, chronic lung disease (ORadj 1.11 [95% CI 1.05-1.17]), weekend admission (ORadj 1.11 [95% CI 1.07-1.16]), presence of cardiogenic shock (ORadj 9.2 [95% CI 8.8-9.7]) and in-hospital arrest (ORadj 20.4 [95% CI 18.9-22.0]) were all independently associated with requiring MV in a multivariate model.
Conclusions: Patient and infarct related factors predict the need for mechanical ventilation in STEMI patients; given the lower rates of revascularization in this population, targeted strategies to improve treatment for STEMI patients with respiratory failure are warranted.
Author Disclosures: T. Metkus: Research Grant; Significant; Research grant, Abbott Diagnostics. A. Albaeni: None. N. Chandra-Strobos: None. S. Eid: None.
- © 2016 by American Heart Association, Inc.