Trends in Coronary Angiography, Revascularization, and Outcomes of Cardiogenic Shock Complicating Non-ST-Elevation Myocardial Infarction.

Autor: Kolte D; Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York., Khera S; Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York., Dabhadkar KC; Division of Cardiology, Department of Medicine, Rhode Island Hospital, Brown University, Providence, Rhode Island., Agarwal S; Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio., Aronow WS; Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York., Timmermans R; Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York., Jain D; Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York., Cooper HA; Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York., Frishman WH; Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York., Menon V; Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio., Bhatt DL; Division of Cardiology, Department of Medicine, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts., Abbott JD; Division of Cardiology, Department of Medicine, Rhode Island Hospital, Brown University, Providence, Rhode Island., Fonarow GC; Division of Cardiology, Department of Medicine, David-Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California., Panza JA; Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York. Electronic address: Julio.Panza@wmchealth.org.
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2016 Jan 01; Vol. 117 (1), pp. 1-9. Date of Electronic Publication: 2015 Oct 22.
DOI: 10.1016/j.amjcard.2015.10.006
Abstrakt: Early revascularization is the mainstay of treatment for cardiogenic shock (CS) complicating acute myocardial infarction. However, data on the contemporary trends in management and outcomes of CS complicating non-ST-elevation myocardial infarction (NSTEMI) are limited. We used the 2006 to 2012 Nationwide Inpatient Sample databases to identify patients aged ≥ 18 years with NSTEMI with or without CS. Temporal trends and differences in coronary angiography, revascularization, and outcomes were analyzed. Of 2,191,772 patients with NSTEMI, 53,800 (2.5%) had a diagnosis of CS. From 2006 to 2012, coronary angiography rates increased from 53.6% to 60.4% in patients with NSTEMI with CS (ptrend <0.001). Among patients who underwent coronary angiography, revascularization rates were significantly higher in patients with CS versus without CS (72.5% vs 62.6%, p <0.001). Patients with NSTEMI with CS had significantly higher risk-adjusted in-hospital mortality (odds ratio 10.09, 95% confidence interval 9.88 to 10.32) as compared to those without CS. In patients with CS, an invasive strategy was associated with lower risk-adjusted in-hospital mortality (odds ratio 0.43, 95% confidence interval 0.42 to 0.45). Risk-adjusted in-hospital mortality, length of stay, and total hospital costs decreased over the study period in patients with and without CS (ptrend <0.001). In conclusion, we observed an increasing trend in coronary angiography and decreasing trend in in-hospital mortality, length of stay, and total hospital costs in patients with NSTEMI with and without CS. Despite these positive trends, overall coronary angiography and revascularization rates remain less than optimal and in-hospital mortality unacceptably high in patients with NSTEMI and CS.
(Copyright © 2016 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: