Epidemiology of cardiogenic shock and cardiac arrest complicating non-ST-segment elevation myocardial infarction: 18-year US study

Abstract

Aims: This study aims to evaluate the impact of the combination of cardiogenic shock (CS) and cardiac arrest (CA) complicating non-ST-segment elevation myocardial infarction (NSTEMI).

Methods and results: Adult (>18 years) NSTEMI admissions using the National Inpatient Sample database (2000 to 2017) were stratified by the presence of CA and/or CS. Outcomes of interest included in-hospital mortality, early coronary angiography, hospitalization costs, and length of stay. Of the 7 302 447 hospitalizations due to NSTEMI, 147 795 (2.0%) had CS only, 155 522 (2.1%) had CA only, and 41 360 (0.6%) had both CS and CA. Compared with 2000, the adjusted odds ratios (ORs) and 95% confidence interval (CIs) for CS, CA, and both CS and CA in 2017 were 3.75 (3.58-3.92), 1.46 (1.42-1.50), and 4.52 (4.16-4.87), respectively (all P < 0.001). The CS + CA (61.2%) cohort had higher multiorgan failure than CS (42.3%) and CA only (32.0%) cohorts, P < 0.001. The CA only cohort had lower rates of overall (52% vs. 59-60%) and early (17% vs. 18-27%) angiography compared with the other groups (all P < 0.001). CS + CA admissions had higher in-hospital mortality compared with those with CS alone (aOR 4.12 [95% CI 4.00-4.24]), CA alone (aOR 1.69 [95% CI 1.65-1.74]), or without CS/CA (aOR 22.66 [95% CI 22.06-23.27]). The presence of CS, either alone or with CA, was associated with higher hospitalization costs and longer hospital length of stay.

Conclusions: The combination of CS and CA is associated with higher rates of acute non-cardiac organ failure and in-hospital mortality in NSTEMI admissions as compared with those with either CS or CA alone.

Keywords: Acute cardiovascular care; Cardiac arrest; Cardiogenic shock; Non-ST-segment elevation myocardial infarction; Outcomes research.

Figure 1

Temporal trends in the prevalence and in‐hospital mortality of NSTEMI admissions complicated by CS and CA. (A) 18‐year unadjusted temporal trends in the prevalence of CS and CA complicating NSTEMI; trends in the rates of CS + CA, CS only, and CA only are magnified in the picture‐in‐picture figure; all P < 0.001 for trend over time; (B) 18‐year adjusted temporal trends (adjusted for age, sex, race, primary payer, socio‐economic status, co‐morbidity, hospital location/teaching status, hospital bedsize, and hospital region) in the prevalence of CS and CA complicating NSTEMI using multivariable logistic regression (2000 as referent year); all P < 0.001 for trend over time; (C) 18‐year unadjusted temporal trends in in‐hospital mortality of NSTEMI admissions complicated by CS and CA; all P < 0.001 for trend over time; (D) 18‐year adjusted temporal trends (adjusted for age, sex, race, primary payer, socio‐economic status, co‐morbidity, hospital location/teaching status, hospital bedsize, and hospital region, acute organ failure, coronary angiography, percutaneous coronary intervention, invasive haemodynamic monitoring, coronary artery bypass grafting, mechanical circulatory support, invasive mechanical ventilation, non‐invasive ventilation, acute haemodialysis, palliative care referral, and do‐not‐resuscitate status) in in‐hospital mortality of NSTEMI admissions complicated by CS and CA using multivariable logistic regression (2000 as referent year); all P < 0.001 for trend over time. CA, cardiac arrest; CS, cardiogenic shock; NSTEMI, non‐ST‐segment elevation myocardial infarction.

Figure 2

Temporal trends in non‐cardiac organ failure in NSTEMI admissions complicated by CS and CA. 18‐year trends of multiorgan failure (A), acute respiratory failure (B), acute renal failure (C), acute hepatic failure (D), acute hematologic failure (E) and acute neurologic failure (F) in NSTEMI admissions; all P < 0.001 for trend. CA, cardiac arrest; CS, cardiogenic shock; NSTEMI, non‐ST‐segment elevation myocardial infarction.

Figure 3

Temporal trends of cardiac procedures in NSTEMI admissions complicated by CS and CA. Eighteen‐year trends in the use of coronary angiography (A), PCI (B), CABG (C), and MCS (D) in NSTEMI admissions; all P < 0.001 for trend. CA, cardiac arrest; CABG, coronary artery bypass grafting; CS, cardiogenic shock; MCS, mechanical circulatory support; NSTEMI, non‐ST‐segment elevation myocardial infarction; PCI, percutaneous coronary intervention.