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Describe the incidence and predictors of acute limb ischemia in patients with acute myocardial infarction complicated by cardiogenic shock.Patients with index hospitalizations for acute myocardial infarction complicated by cardiogenic shock from 2016 to 2019 in the U.S. National Readmission Database were identified. We evaluated the incidence of acute limn ischemia and its associated mortality, length of stay, and cost of hospitalization. We used multivariable logistic regression to determine independent predictors of acute limb ischemia in this population.A total of 84,615 patients had acute myocardial infarction complicated by cardiogenic shock and 1302 (1.54%) developed acute limb ischemia. The rates of acute limb ischemia increased from 1.29% in 2016 to 1.66% in 2019 (p=0.002). Utilization of microaxial mechanical circulatory support increased from 2.25% in 2016 to 13.36% in 2019 (p=0.0001). The major predictors of acute limb ischemia included peripheral arterial disease (OR, 7.34, 95% CI 6.12 to 8.81), veno-arterial extracorporeal membrane oxygenation (OR, 4.40, 95% CI of 3.19 to 6.07), and microaxial mechanical circulatory support (OR, 3.12, 95% CI of 2.74 to 3.55). Acute limb ischemia in patients with cardiogenic shock was associated higher mortality (39.20% vs 33.53%, p=0.0001).This nationwide observational study shows that acute limb ischemia is an important complication of acute myocardial infarction with cardiogenic shock. This complication is associated with higher mortality. In addition to peripheral artery disease the use of mechanical circulatory devices was associated with significantly higher rates of acute limb ischemia. |
