Abstract 17757: Use of Mechanical and Non-Invasive Ventilation in STEMI: 12-year Trends and Prognostic Impact From the National Inpatient Sample
Introduction: There are few data detailing the incidence and prognostic impact of the use of invasive mechanical ventilation (IMV) and non-invasive ventilation (NIV) in acute ischemic heart disease.
Hypothesis: The use of IMV and NIV in STEMI is common and such patients are at a higher risk of mortality.
Methods: We used the National Inpatient Sample to characterize the use of IMV and NIV in patients with STEMI over a 12-year period. STEMI, IMV, and NIV use were identified using ICD-9-CM codes. Patients with STEMI who required IMV or NIV within 24 hours of hospital admission were compared to those who received neither modality. Cox proportional hazard regression was performed to quantify the magnitude of associated hazard for in-hospital mortality in patients requiring IMV and NIV.
Results: Of 1,867,114 STEMI patients included, 72,220 were treated with IMV (3.9%) and 7030 were treated with NIV (0.4%). The use of both IMV and NIV in STEMI increased over 12 years (Figure: P < 0.001 for trend). Mortality was 46% for patients requiring IMV and 18% for those requiring NIV compared to 5% for those requiring neither (P<0.001 for both comparisons). After multivariate adjustment including for age, gender, race, Charlson comorbidity index, chronic pulmonary disease, smoking, obesity, weekend versus weekday admission, in-hospital cardiac arrest, development of cardiogenic shock and admission to a teaching vs. non-teaching hospital, the need for IMV and NIV in STEMI remained associated with increased in-hospital mortality (hazard ratio [HR]: 2.48 (2.35-2.62); p < 0.001 and HR: 1.73 (1.50-1.99); p < 0.001, respectively).
Conclusion: Approximately 1 in 23 patients with STEMI will require respiratory support with noninvasive or mechanical ventilation, and the incidence is increasing over time. Need for respiratory support in STEMI patients confers adverse prognosis. Studies to optimize care and to identify the optimal mode of respiratory support for acute MI patients are needed.
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.