Contemporary prevalence, trends, and outcomes of coronary chronic total occlusions in acute myocardial infarction with cardiogenic shock

Abstract

Background There are limited data on the prevalence and outcomes of chronic total occlusions (CTO) of the coronary artery in acute myocardial infarction with cardiogenic shock (AMI-CS) patients. Methods Using the National Inpatient Sample, all admissions with AMI-CS that underwent diagnostic angiography between January 1, 2008, and December 31, 2014, were included. CTO, percutaneous coronary intervention (PCI), comorbidities and concomitant cardiac arrest was identified for all admissions. Outcomes of interest included temporal trends, in-hospital mortality, and resource utilization in cohorts with and without CTO. Results In this 7-year period, 163,628 admissions with AMI-CS admissions met the inclusion criteria, with 68% being ST-elevation AMI-CS. CTO was noted in 27,343 (16.7%) admissions, with an increase in prevalence during the study period. The cohort with CTOs was more likely to be male and bearing private insurance. The CTO cohort had higher cardiovascular comorbidity, higher rates of cardiac arrest and higher use of PCI and mechanical circulatory support. The presence of a CTO was independently associated with higher in-hospital mortality (adjusted odds ratio 1.20 [95% confidence interval 1.16–1.23]; p < 0.001). The cohort with CTO had lower resource utilization (hospital stay and hospitalization costs) but was discharged more frequently to other hospitals. The presence of a CTO was associated with higher in-hospital mortality in the sub-groups of ST-elevation AMI-CS (31.5% vs. 28.7%; p < 0.001) and non-ST-elevation AMI-CS (24.8% vs. 23.2%; p < 0.001). Conclusions In this cohort of AMI-CS admissions that underwent diagnostic angiography, the presence of a CTO identified a higher risk cohort that had higher in-hospital mortality.

Prognostic Impact of Percutaneous Coronary Intervention of Chronic Total Occlusion in Acute and Periprocedural Myocardial Infarction

“…After adjusting for confounders, the presence of CTO was significantly associated with cardiac and all-cause mortality at 30-days and 5-years follow-ups. Consistent with these results, Vallabhajosyula et al demonstrated that the presence of CTO in patients with STEMI and cardiogenic shock was associated with increased in-hospital mortality [ 68 ]. Interestingly, the impact of the number of CTO on clinical outcome was also identified [ 69 ].…”

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

“…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).…”

Pulmonary artery catheter use in acute myocardial infarction‐cardiogenic shock

“…Demographic characteristics, hospital characteristics, acute organ failure, coronary angiography, percutaneous coronary interventions (PCI), and mechanical circulatory support (MCS) use were identified for all admissions using previously used methodologies from our group. [2][3][4][5]8,9,[28][29][30][31][32][33][34][35] Acute noncardiac organ failure was classified as respiratory (acute respiratory failure, other pulmonary insufficiency, acute respiratory distress syndrome, respiratory arrest, and ventilator management), renal (acute kidney injury), and hepatic (acute hepatic failure, hepatic encephalopathy, hepatic infection, and hepatitis unspecified), hematologic (defibrination syndrome, acquired coagulation factor deficiency, coagulation defect, and thrombocytopenia), and neurologic (anoxic brain injury, acute encephalopathy, coma, altered consciousness, and electroencephalogram). [3][4][5]9,30,32 Similar to prior literature from the HCUP-NIS, we used the procedure day for RHC/PAC placement to time concomitant coronary angiography, PCI, MCS, and invasive mechanical ventilation.…”