Key result
STEMI cardiogenic shock incidence rises over time while in-hospital mortality odds drop ~71%.
Why the study?
Data were limited on the temporal trends, incidence, and outcomes of ST-segment-elevation myocardial infarction-cardiogenic shock.
Observational (n=4,300,000)
Yes
Effect estimate: aOR 0.29 (95% CI 0.28-0.31)
Absolute Event Rate: 32.7% vs 49.6%
p-value: p=<0.001
Between 2000 and 2017 in the US, the incidence of cardiogenic shock complicating STEMI increased 2.5-fold, but in-hospital mortality significantly decreased alongside increased use of coronary angiography and PCI.
STEMI-CS incidence rose while mortality fell; extends observational trends but leaves open drivers of increasing shock rates.
BACKGROUND: There are limited data on the temporal trends, incidence, and outcomes of ST-segment-elevation myocardial infarction-cardiogenic shock (STEMI-CS). METHODS: Adult (>18 years) STEMI-CS admissions were identified using the National Inpatient Sample (2000-2017) and classified by tertiles of admission year (2000-2005, 2006-2011, 2012-2017). Outcomes of interest included temporal trends, acute organ failure, cardiac procedures, in-hospital mortality, hospitalization costs, and length of stay. RESULTS: In ∼4.3 million STEMI admissions, CS was noted in 368,820 (8.5%). STEMI-CS incidence increased from 5.8% in 2000 to 13.0% in 2017 (patient and hospital characteristics adjusted odds ratio [aOR] 2.45 [95% confidence interval {CI} 2.40-2.49]; P < 0.001). Multiorgan failure increased from 55.5% (2000-2005) to 74.3% (2012-2017). Between 2000 and 2017, coronary angiography and percutaneous coronary intervention use increased from 58.8% to 80.1% and 38.6% to 70.6%, whereas coronary artery bypass grafting decreased from 14.9% to 10.4% (all P < 0.001). Over the study period, the use of intra-aortic balloon pump (40.6%-37.6%) decreased, and both percutaneous left ventricular assist devices (0%-12.9%) and extra-corporeal membrane oxygenation (0%-2.8%) increased (all P < 0.001). In hospital mortality decreased from 49.6% in 2000 to 32.7% in 2017 (aOR 0.29 [95% CI 0.28-0.31]; P < 0.001). During the 18-year period, hospital lengths of stay decreased, hospitalization costs increased and use of durable left ventricular assist device /cardiac transplantation remained stable (P > 0.05). CONCLUSIONS: In the United States, incidence of CS in STEMI has increased 2.5-fold between 2000 and 2017, while in-hospital mortality has decreased during the study period. Use of coronary angiography and PCI increased during the study period.
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Vallabhajosyula et al. (2021) conducted an observational in ST-segment-elevation myocardial infarction-cardiogenic shock (STEMI-CS) (n=4,300,000). Admission year 2017 vs. Admission year 2000 was evaluated on In-hospital mortality (aOR 0.29, 95% CI 0.28-0.31, p=<0.001). Between 2000 and 2017, the incidence of cardiogenic shock in STEMI increased from 5.8% to 13.0%, while in-hospital mortality decreased from 49.6% to 32.7% (aOR 0.29; 95% CI 0.28-0.31; P<0.001).
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