Acute myocardial infarction-cardiogenic shock in patients with prior coronary artery bypass grafting: A 16-year national cohort analysis of temporal trends, management and outcomes

Vallabhajosyula, Saraschandra; Kumar, Vinayak; Vallabhajosyula, Saarwaani; Subramaniam, Anna V.; Patlolla, Sri Harsha; Verghese, Dhiran; Ya’qoub, Lina; Stulak, John M.; Sandhu, Gurpreet S.; Prasad, Abhiram; Holmes, David R.; Barsness, Gregory W.

doi:10.1016/j.ijcard.2020.02.033

Cited by 35 publications

(30 citation statements)

References 40 publications

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“…16 Demographic characteristics, hospital characteristics, acute organ failure, mechanical circulatory support, cardiac procedures, and noncardiac organ support use were identified for all admissions using previously used methods from our group. [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] Similar to previous literature, we defined early coronary angiography (CA) as that performed on the day of hospital admission (day 0). 21,30,31 We identified the timing of CA and PCI relative to the day of admission.…”

Section: Study Population Variables and Outcomesmentioning

confidence: 99%

Weekend Effect in the Management and Outcomes of Acute Myocardial Infarction in the United States, 2000-2016

Vallabhajosyula

Patlolla

Miller

et al. 2020

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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Objective: To assess the effects of weekend admission vs weekday admission on the management and outcomes of acute myocardial infarction (AMI). Methods: Adult ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) hospital admissions were identified using the National (Nationwide) Inpatient Sample (2000-2016). Interhospital transfers were excluded. Timing of coronary angiography (CA) and percutaneous coronary intervention (PCI) relative to the day of admission was identified. Outcomes of interest included in-hospital mortality, receipt of early CA, timing of CA and PCI, resource utilization, and discharge disposition for weekend vs weekday admissions. Results: Of the 9,041,819 AMI admissions, 2,406,876 (26.6%) occurred on weekends. Compared with 2000, in 2016 there was an increase in weekend STEMI (adjusted odds ratio [aOR], 1.12; 95% CI, 1.08-1.16; P<.001) but not NSTEMI (aOR, 1.01; 95% CI, 0.98-1.02; P¼.21) admissions. Compared with weekday admissions, weekend admissions received comparable CA (59.9% vs 58.8%) and PCI (38.4% vs 37.6%) and specifically lower rates of early CA (hospital day 0) (26.0% vs 20.8%; P<.001). There was a steady increase in CA and PCI use during the 17-year period. Mean AE SD time to CA was higher in the weekend group vs the weekday group (1.2AE1.8 vs 1.0AE1.8 days; P<.001). Weekend admission did not influence in-hospital mortality (aOR, 1.01; 95% CI, 1.00-1.01; P¼.05) but had fewer discharges to home (58.7% vs 59.7%; P<.001). Conclusion: Despite small differences in CA and PCI, there were no differences in in-hospital mortality of AMI admissions on weekdays vs weekends in the United States in the contemporary era.

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Section: Study Population Variables and Outcomesmentioning

confidence: 99%

Weekend Effect in the Management and Outcomes of Acute Myocardial Infarction in the United States, 2000-2016

Vallabhajosyula

Patlolla

Miller

et al. 2020

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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“…Deyo's modification of the Charlson Comorbidity Index was used to identify the burden of comorbid conditions ( Supplementary Table S1) [27]. All variables were identified for all admissions using previously used methodologies from our group [5][6][7][12][13][14][15][16][17][19][20][21][28][29][30][31][32][33][34][35][36][37][38]. AKI was identified using ICD-9CM 584 (acute renal failure (ARF), 584.5 (ARF with tubular necrosis), 584.6 (ARF with renal cortical necrosis), 584.7 (ARF with papillary necrosis), 584.8 (ARF with another pathological lesion) and 584.9 (ARF, unspecified), which has been shown to have a high specificity (98%) and negative predictive value (96%) [5].…”

Section: Study Population Variables and Outcomesmentioning

confidence: 99%

Contemporary National Outcomes of Acute Myocardial Infarction-Cardiogenic Shock in Patients with Prior Chronic Kidney Disease and End-Stage Renal Disease

Vallabhajosyula

Ya’qoub

Kumar

et al. 2020

JCM

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Background: There are limited data on acute myocardial infarction with cardiogenic shock (AMI-CS) stratified by chronic kidney disease (CKD) stages. Objective: To assess clinical outcomes in AMI-CS stratified by CKD stages. Methods: A retrospective cohort of AMI-CS during 2005–2016 from the National Inpatient Sample was categorized as no CKD, CKD stage-III (CKD-III), CKD stage-IV (CKD-IV) and end-stage renal disease (ESRD). CKD-I/II were excluded. Outcomes included in-hospital mortality, use of coronary angiography, percutaneous coronary intervention (PCI) and mechanical circulatory support (MCS). We also evaluated acute kidney injury (AKI) and acute hemodialysis in non-ESRD admissions. Results: Of 372,412 AMI-CS admissions, CKD-III, CKD-IV and ESRD comprised 20,380 (5.5%), 7367 (2.0%) and 18,109 (4.9%), respectively. Admissions with CKD were, on average, older, of the White race, bearing Medicare insurance, of a lower socioeconomic stratum, with higher comorbidities, and higher rates of acute organ failure. Compared to the cohort without CKD, CKD-III, CKD-IV and ESRD had lower use of coronary angiography (72.7%, 67.1%, 56.9%, 61.1%), PCI (53.7%, 43.8%, 38.4%, 37.6%) and MCS (47.9%, 38.3%, 33.3%, 34.2%), respectively (all p < 0.001). AKI and acute hemodialysis use increased with increase in CKD stage (no CKD–38.5%, 2.6%; CKD-III–79.1%, 6.5%; CKD-IV–84.3%, 12.3%; p < 0.001). ESRD (adjusted odds ratio [OR] 1.25 [95% confidence interval {CI} 1.21–1.31]; p < 0.001), but not CKD-III (OR 0.72 [95% CI 0.69–0.75); p < 0.001) or CKD-IV (OR 0.82 [95 CI 0.77–0.87] was predictive of in-hospital mortality. Conclusions: CKD/ESRD is associated with lower use of evidence-based therapies. ESRD was an independent predictor of higher in-hospital mortality in AMI-CS.

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“…There are several potential explanations for this finding. First, we found a higher burden of comorbidities and significantly higher rate of prior CABG in our Medicare population, both of which are associated with lower utilization of coronary angiography (37). Second, compared to other groups our study reports that Medicare patients were more often admitted to rural hospitals than urban hospitals.…”

Section: Discussionmentioning

confidence: 45%

Influence of primary payer status on non-ST-segment elevation myocardial infarction: 18-year retrospective cohort national temporal trends, management and outcomes

Vallabhajosyula¹,

Desai²,

Sundaragiri³

et al. 2021

Ann Transl Med

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Background: The role of insurance on outcomes in non-ST-segment-elevation myocardial infarction (NSTEMI) patients is limited in the contemporary era.Methods: From the National Inpatient Sample, adult NSTEMI admissions were identified [2000][2001][2002][2003][2004][2005][2006][2007][2008][2009][2010][2011][2012][2013][2014][2015][2016][2017].Expected primary payer was classified into Medicare, Medicaid, private, uninsured and others. Outcomes included in-hospital mortality, overall and early coronary angiography, percutaneous coronary intervention (PCI), resource utilization and discharge disposition.Results: Of the 7,290,565 NSTEMI admissions, Medicare, Medicaid, private, uninsured and other insurances were noted in 62.9%, 6.1%, 24.1%, 4.6% and 2.3%, respectively. Compared to others, those with Medicare insurance older (76 vs. 53-60 years), more likely to be female (48% vs. 25-44%), of white race, and with higher comorbidity (all P<0.001). Population from the Medicare cohort had higher in-hospital mortality (5.6%) compared to the others (1.9-3.4%), P<0.001. With Medicare as referent, in-hospital mortality was higher in other {adjusted odds ratio (aOR) 1.15 [95% confidence interval (CI), 1.11-1.19]; P<0.001}, and lower in Medicaid [aOR 0.95 (95% CI, 0.92-0.97); P<0.001], private [aOR 0.77 (95% CI, 0.75-0.78); P<0.001] and uninsured cohorts [aOR 0.97 (95% CI, 0.94-1.00); P=0.06] in a multivariable analysis. Coronary angiography (overall 52% vs. 65-74%; early 15% vs. 22-27%) and PCI (27% vs. 35-44%) were used lesser in the Medicare population. The Medicare population had longer lengths of stay, lowest hospitalization costs and fewer home discharges.Conclusions: Compared to other types of primary payers, NSTEMI admissions with Medicare insurance had lower use of coronary angiography and PCI, and higher in-hospital mortality.

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Acute myocardial infarction-cardiogenic shock in patients with prior coronary artery bypass grafting: A 16-year national cohort analysis of temporal trends, management and outcomes

Cited by 35 publications

References 40 publications

Weekend Effect in the Management and Outcomes of Acute Myocardial Infarction in the United States, 2000-2016

Weekend Effect in the Management and Outcomes of Acute Myocardial Infarction in the United States, 2000-2016

Contemporary National Outcomes of Acute Myocardial Infarction-Cardiogenic Shock in Patients with Prior Chronic Kidney Disease and End-Stage Renal Disease

Influence of primary payer status on non-ST-segment elevation myocardial infarction: 18-year retrospective cohort national temporal trends, management and outcomes

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