Epidemiology of cardiogenic shock and cardiac arrest complicating non‐ST‐segment elevation myocardial infarction: 18‐year US study

Abstract

Aims This study aims to evaluate the impact of the combination of cardiogenic shock (CS) and cardiac arrest (CA) complicating non-ST-segment elevation myocardial infarction (NSTEMI). Methods and results Adult (>18 years) NSTEMI admissions using the National Inpatient Sample database (2000 to 2017) were stratified by the presence of CA and/or CS. Outcomes of interest included in-hospital mortality, early coronary angiography, hospitalization costs, and length of stay. Of the 7 302 447 hospitalizations due to NSTEMI, 147 795 (2.0%) had CS only, 155 522 (2.1%) had CA only, and 41 360 (0.6%) had both CS and CA. Compared with 2000, the adjusted odds ratios (ORs) and 95% confidence interval (CIs) for CS, CA, and both CS and CA in 2017 were 3.75 (3.58-3.92), 1.46 (1.42-1.50), and 4.52 (4.16-4.87), respectively (all P < 0.001). The CS + CA (61.2%) cohort had higher multiorgan failure than CS (42.3%) and CA only (32.0%) cohorts, P < 0.001. The CA only cohort had lower rates of overall (52% vs. 59-60%) and early (17% vs. 18-27%) angiography compared with the other groups (all P < 0.001). CS + CA admissions had higher in-hospital mortality compared with those with CS alone (aOR 4.12 [95% CI 4.00-4.24]), CA alone (aOR 1.69 [95% CI 1.65-1.74]), or without CS/CA ). The presence of CS, either alone or with CA, was associated with higher hospitalization costs and longer hospital length of stay. Conclusions The combination of CS and CA is associated with higher rates of acute non-cardiac organ failure and in-hospital mortality in NSTEMI admissions as compared with those with either CS or CA alone.

Cardiogenic Shock From Heart Failure Versus Acute Myocardial Infarction: Clinical Characteristics, Hospital Course, and 1-Year Outcomes

“…In the AMI-CS cohort, cardiac arrest was independently associated with increased risk of 1-year mortality, which has also been shown in recent observational studies. 23,24 In the HF-CS group, baseline chronic kidney disease (with an index GFR <60 mL/min) was independently associated with increased risk of 1-year mortality, underscoring the importance of the cardio-renal axis in this patient population and extending outcomes seen in heart failure patients across the spectrum of renal function. 25 It should be underscored that, when appropriate, routine involvement of hospice or palliative care may be useful in the management of both AMI-CS and patients with HF-CS, a key intervention not reported in our study.…”

Escalation strategies, management, and outcomes of acute myocardial infarction‐cardiogenic shock patients receiving percutaneous left ventricular support

“…The use of ECMO in this population offers a unique challenge due to its role in cardiopulmonary resuscitation 20,44 . In that light, it is important to understand the role of cardiac arrest in patients with AMI‐CS, since this often represents a sicker phenotype with higher rates of acute noncardiac organ failure and in‐hospital mortality 45,46 . There is critical need to incorporate detailed pharmacological support assessment into the clinical decision‐making for MCS initiation and escalation thereby providing objective criteria for universal applicability 47 .…”

“…20,44 In that light, it is important to understand the role of cardiac arrest in patients with AMI-CS, since this often represents a sicker phenotype with higher rates of acute noncardiac organ failure and in-hospital mortality. 45,46 There is critical need to incorporate detailed pharmacological support assessment into the clinical decision-making for MCS initiation and escalation thereby providing objective criteria for universal applicability. 47 Finally, the high resource utilization, feasible exit strategies, and anticipated clinical outcomes associated with advanced MCS devices need to be considered by a multidisciplinary team of specialists before implantation.…”

Calycosin protects against oxidative stress‐induced cardiomyocyte apoptosis by activating aldehyde dehydrogenase 2

“…Myocardial infarction (MI) is the most common cause of heart damage and a major cause of mortality in people suffering from coronary artery disease (CAD) (Vallabhajosyula et al, 2021). MI is mediated, at least in part, by an increase in oxidative stress, which plays an essential role in the pathophysiology of cardiac disorders (Kompa et al, 2022; Lv et al, 2021; Rezvan, 2017).…”