Resources for cardiovascular healthcare associated with 30-day mortality in acute myocardial infarction with cardiogenic shock

Abstract

Background Although primary percutaneous coronary intervention (PCI) and mechanical circulatory support (MCS), such as extracorporeal membrane oxygenation (ECMO) or intra-aortic balloon pumping (IABP), have been widely used for acute myocardial infarction patients with cardiogenic shock (AMICS), their in-hospital mortality remains high. This study aimed to investigate the association of cardiovascular healthcare resources with 30-day mortality in AMICS. Methods This was an observational study using a Japanese nationwide administrative data (JROAD-DPC) of 260,543 AMI patients between April 2012 and March 2018. Of these, 45,836 AMICS patients were divided into three categories based on MCS use: with MCS (ECMO with/without IABP), IABP only, or without MCS. Certified hospital density and number of board-certified cardiologists were used as a metric of cardiovascular care supply. We estimated the association of MCS use, cardiovascular care supply, and 30-day mortality. Results The 30-day mortality was 71.2% for the MCS, 23.9% for IABP only, and 37.8% for the group without MCS. The propensity score-matched and inverse probability-weighted Cox frailty models showed that primary PCI was associated with a low risk for mortality. Higher hospital density and larger number of cardiologists in the responsible hospitals were associated with a lower risk for mortality. Conclusions Although the 30-day mortality remained extremely high in AMICS, indication of primary PCI and improvement in providing cardiovascular healthcare resources associated with the short-term prognosis of AMICS.

Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on the Severity and the Mortality of Acute Myocardial Infarction in Japan — Analysis From the JROAD-DPC Database —

“…This might be because COVID-19 directly impacts on coronary circulation and/or myocardial injury causing an increase in mortality. 3 Additionally, in our study, although the proportion of patients treated with PCI in the before COVID-19 pandemic group was similar to those in previous reports that extracted data from the JROAD DPC, 19 the proportion in the COVID-19-positive group was low compared with the before COVID-19 pandemic group. Thus, the decrease in the proportion of patients treated with PCI might also be one of the reasons for the higher mortality in the COVID-19-positive group.…”

Acute myocardial infarction caused by Kawasaki disease requires more intensive therapy: Insights from the Japanese registry of All Cardiac and Vascular Diseases—Diagnosis Procedure combination

“…Previous studies using JROAD‐DPC data reported a ratio of male to female AMI patients of about 7 to 3 7,8 . On the other hand, our study population was 89.3% male.…”

“…Previous studies using JROAD-DPC data reported a ratio of male to female AMI patients of about 7 to 3. 7,8 On the other hand, our study population was 89.3% male. In contrast to these other studies investigating AMI patients of all ages, our study investigated AMI patients between 0 and 60 years old because KD was first reported in Japan in 1967 and diagnosed while patients were infants or young | 1177 children.…”

Clinical Characteristics and Outcomes of Patients Presenting With Acute Myocardial Infarction Without Cardiogenic Shock

“…The present study was a retrospective observational study based on a nationwide Japanese administrative case-mix Diagnostic Procedure Combination (DPC) database, the Japanese Registry Of All cardiac and vascular Disease (JROAD)-DPC. [4][5][6] In brief, the JROAD-DPC database is DPC-based payment health insurance claim data about hospitalization due to cardiovascular diseases collected…”

“…The remaining participants were divided into AMI-CS and AMI-NCS groups based on their condition at admission. 5 The AMI-CS, equivalent to the SCAI C/D/E group, was defined as Killip classification 3 or 4 that met at least one of the following criteria: (1) mechanical circulatory support use; or (2) intravenous administration of catecholamines on admission. Patients with Killip classification 3 (n=9,598) and 4 (n=6,691), or out-of-hospital cardiac arrest (n=484) were also excluded for the possibility of CS.…”