Acute Noncardiac Organ Failure in Acute Myocardial Infarction With Cardiogenic Shock

Vallabhajosyula, Saraschandra; Dunlay, Shannon M.; Prasad, Abhiram; Kashani, Kianoush; Sakhuja, Ankit; Gersh, Bernard J.; Jaffe, Allan S.; Holmes, David R.; Barsness, Gregory W.

doi:10.1016/j.jacc.2019.01.053

Cited by 164 publications

(191 citation statements)

References 37 publications

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“…We observed a stepwise increase in hospital mortality as a function of increasing number of organ failures, similar to a recent study of nearly 1 million patients with sepsis by Shankar‐Hari et al As in our study, the mortality risk varied with individual organ failures and specific combinations of organ failure . A stepwise increase in hospital mortality associated with an increasing number of acute organ failures was observed among patients with cardiogenic shock due to acute myocardial infarction in the Nationwide Inpatient Sample using ICD‐9 discharge diagnoses to define organ failure . We replicated these results in our broader CICU population using a more objective SOFA‐based definition of organ failure near the time of CICU admission.…”

Section: Discussionsupporting

confidence: 89%

Early noncardiovascular organ failure and mortality in the cardiac intensive care unit

Jentzer

Wiley

Bennett

et al. 2020

Clinical Cardiology

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Background: Noncardiac organ failure has been associated with worse outcomes among a cardiac intensive care unit (CICU) population.Hypothesis: We hypothesized that early organ failure based on the sequential organ failure assessment (SOFA) score would be associated with mortality in CICU patients.Methods: Adult CICU patients from 2007 to 2015 were reviewed. Organ failure was defined as any SOFA organ subscore ≥3 on the first CICU day. Organ failure was evaluated as a predictor of hospital mortality and postdischarge survival after adjustment for illness severity and comorbidities.Results: We included 10 004 patients with a mean age of 67 ± 15 years (37% female). Admission diagnoses included acute coronary syndrome in 43%, heart failure in 46%, cardiac arrest in 12%, and cardiogenic shock in 11%. Organ failure was present in 31%, including multiorgan failure in 12%. Hospital mortality was higher in patients with organ failure (22% vs 3%, adjusted OR 3.0, 95% CI 2.5-3.7, P < .001).After adjustment, each failing organ system predicted twofold higher odds of hospital mortality (adjusted OR 1.9, 95% CI 1.1-2.1, P < .001). Mortality risk was highest with cardiovascular, coagulation and liver failure. Among hospital survivors, organ failure was associated with higher adjusted postdischarge mortality risk (P < .001); multiorgan failure did not confer added long-term mortality risk.Conclusions: Early noncardiovascular organ failure, especially multiorgan failure, is associated with increased hospital mortality in CICU patients, and this risk continues Abbreviations: APACHE, acute physiology and chronic health evaluation; BMI, body mass index; CCI, Charlson comorbidity index; CI, confidence interval; CICU, cardiac intensive care unit; IABP, intra-aortic balloon pump; LOS, length of stay; OASIS, Oxford Acute Severity of Illness Score; OR, odds ratio; PAC, pulmonary artery catheter; PCI, percutaneous coronary intervention; SOFA, sequential organ failure assessment.

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Section: Discussionsupporting

confidence: 89%

Early noncardiovascular organ failure and mortality in the cardiac intensive care unit

Jentzer

Wiley

Bennett

et al. 2020

Clinical Cardiology

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“…During the period between 1 January 2000 through 31 December 2016, a retrospective cohort of admissions from the HCUP-NIS with a primary diagnosis of AMI (International Classification of Disease-9 Clinical Modification [ICD-9CM] 410.x; International Classification of Disease-10 Clinical Modification [ICD-10CM] I21.x-22.x) receiving ECMO support (ICD-9CM 39.65; ICD-10CM 5A15223) were identified consistent with prior literature [7]. Deyo's modification of Charlson Comorbidity Index was used to identify co-morbid diseases and prior methodology was used to identify cardiac and non-cardiac procedures [2,3,7,8,11,[13][14][15][16][17][18][19][20][21][22][23]. We identified relevant complications and categorized them as (a) vascular complications-arterial injury, acquired arterio-venous fistula, and vascular complications requiring surgery; (b) lower limb amputation; (c) hematologic-post-operative hemorrhage, hemolytic anemia, thrombocytopenia, and blood transfusion; and (d) neurologic-ischemic or hemorrhagic stroke ( Supplementary Table S1).…”

Section: Methodsmentioning

confidence: 99%

Complications in Patients with Acute Myocardial Infarction Supported with Extracorporeal Membrane Oxygenation

Vallabhajosyula

Bell

Sandhu

et al. 2020

JCM

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Background: There are limited data on complications in acute myocardial infarction (AMI) admissions receiving extracorporeal membrane oxygenation (ECMO). Methods: Adult (>18 years) admissions with AMI receiving ECMO support were identified from the National Inpatient Sample database between 2000 and 2016. Complications were classified as vascular, lower limb amputation, hematologic, and neurologic. Outcomes of interest included temporal trends, in-hospital mortality, hospitalization costs, and length of stay. Results: In this 17-year period, in~10 million AMI admissions, ECMO support was used in 4608 admissions (<0.01%)-mean age 59.5 ± 11.0 years, 75.7% men, 58.9% white race. Median time to ECMO placement was 1 (interquartile range [IQR] 0-3) day. Complications were noted in 2571 (55.8%) admissions-vascular 6.1%, lower limb amputations 1.1%, hematologic 49.3%, and neurologic 9.9%. There was a steady increase in overall complications during the study period (21.1% in 2000 vs. 70.5% in 2016). The cohort with complications, compared to those without complications, had comparable adjusted in-hospital mortality (60.7% vs. 54.0%; adjusted odds ratio 0.89 [95% confidence interval 0.77-1.02]; p = 0.10) but longer median hospital stay (12 [IQR 5-24] vs. 7 [IQR 3-21] days), higher median hospitalization costs ($458,954 [IQR 260,871] vs. 302,255 [IQR 173,660]), fewer discharges to home (14.7% vs. 17.9%), and higher discharges to skilled nursing facilities (44.1% vs. 33.9%) (all p < 0.001). Conclusions: Over half of all AMI admissions receiving ECMO support develop one or more severe complications. Complications were associated with higher resource utilization during and after the index hospitalization.

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“…[1][2][3] In unselected AKI patients, female sex was noted to be associated with lower mortality. [1][2][3] In unselected AKI patients, female sex was noted to be associated with lower mortality.…”

Section: Introductionmentioning

confidence: 96%

“…Cardiogenic shock complicating acute myocardial infarction (AMI-CS) is frequently associated with acute kidney injury (AKI), which has an adverse prognosis. [1][2][3] In unselected AKI patients, female sex was noted to be associated with lower mortality. 4 However, there are limited data on sex-specific differences in AKI in hospitalized US patients with AMI-CS.…”

Section: Introductionmentioning

confidence: 96%

Sex disparities in acute kidney injury complicating acute myocardial infarction with cardiogenic shock

et al. 2019

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Aims To evaluate sex‐specific disparities in acute kidney injury (AKI) complicating acute myocardial infarction‐related cardiogenic shock (AMI‐CS) in the United States. Methods and results This was a retrospective cohort study from 2000 to 2014 from the National Inpatient Sample (20% sample of all hospitals in the United States). Patients >18 years admitted with a primary diagnosis of AMI and concomitant CS that developed AKI were included. The endpoints of interest were the prevalence, trends, and outcomes of men and women with AKI in AMI‐CS. Multivariable hierarchical logistic regression was used to control for confounding, and a two‐sided P < 0.05 was considered statistically significant. During this 15 year period, 440 257 admissions with AMI‐CS met the inclusion criteria, with AKI noted in 155 610 (35.3%). Women constituted 36.3% of the cohort and were older, of non‐White race, and with higher co‐morbidity compared with men. Women with AKI less often received coronary angiography (59% vs. 66%), percutaneous coronary intervention (39% vs. 43%), mechanical circulatory support (39% vs. 48%), mechanical ventilation (49% vs. 54%), and haemodialysis (9% vs. 10%) compared with men (all P < 0.001). Adjusted in‐hospital mortality was higher in women—odds ratio 1.16 (95% confidence interval 1.14–1.19); P < 0.001—compared with men. Women had shorter lengths of stay (12 ± 14 vs. 13 ± 14 days), lower hospital costs ($150 071 ± 180 796 vs. $181 260 ± 209 674), and were less often discharged to home (19% vs. 31%) (all P < 0.001). Conclusions Women with AKI in AMI‐CS received fewer cardiac and non‐cardiac interventions, had higher in‐hospital mortality, and were less often discharged to home compared with men.

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Acute Noncardiac Organ Failure in Acute Myocardial Infarction With Cardiogenic Shock

Cited by 164 publications

References 37 publications

Early noncardiovascular organ failure and mortality in the cardiac intensive care unit

Early noncardiovascular organ failure and mortality in the cardiac intensive care unit

Complications in Patients with Acute Myocardial Infarction Supported with Extracorporeal Membrane Oxygenation

Sex disparities in acute kidney injury complicating acute myocardial infarction with cardiogenic shock

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