Elsevier

The American Journal of Cardiology

Volume 133, 15 October 2020, Pages 15-22
The American Journal of Cardiology

Long-Term Outcomes of Acute Myocardial Infarction With Concomitant Cardiogenic Shock and Cardiac Arrest

https://doi.org/10.1016/j.amjcard.2020.07.044Get rights and content

This study sought to evaluate long-term mortality and major adverse cardiac and cerebrovascular events (MACCE) in patients with cardiac arrest (CA) and cardiogenic shock (CS) complicating acute myocardial infarction (AMI). This was a retrospective cohort study using an administrative claims database. AMI patients from January 1, 2010 to May 31, 2018 were stratified into CA + CS, CA only, CS only, and AMI alone cohorts. Outcomes of interest were long-term mortality and MACCE (death, AMI, cerebrovascular accident, unplanned revascularization) in AMI survivors. A total 163,071 AMI patients were included with CA + CS, CA only, and CS only in 2.4%, 5.0%, and 4.0%, respectively. The CA + CS cohort had higher rates of multiorgan failure, mechanical circulatory support use and less frequent coronary angiography use. In-hospital mortality was noted in 10,686 (6.6%) patients – CA + CS (48.8%), CA only (35.9%), CS only (24.1%), and AMI alone (2.9%; p < 0.001). Over 23.5 ± 21.7 months follow-up after hospital discharge, patients with CA + CS (hazard ratio [HR] 1.36 [95% confidence interval {CI} 1.19 to 1.55]), CA only (HR 1.16 [95% CI 1.08 to 1.25]), CS only (HR 1.39 [95% CI 1.29 to 1.50]) had higher all-cause mortality compared with AMI alone (all p < 0.001). Presence of CS, either alone (HR 1.22 [95% CI 1.16 to 1.29]; p < 0.001) or with CA (HR 1.18 [95% CI 1.07 to 1.29]; p < 0.001), was associated with higher MACCE compared with AMI alone. In conclusion, CA + CS, CA, and CS were associated with worse long-term survival. CA and CS continue to influence outcomes beyond the index hospitalization in AMI survivors.

Section snippets

Methods

This study used de-identified administrative claims data from the OptumLabs Data Warehouse, which includes medical and pharmacy claims and enrollment records for commercial and Medicare Advantage enrollees. The database contains longitudinal health information on enrollees and patients, representing a diverse mixture of ages, ethnicities and geographical regions across the United States.15, 16, 17 The data, analytic methods, and study materials will not be made available to other researchers

Results

During this 8.5-year period, there were 163,071 patients admitted with a primary diagnosis of AMI, of which CA and CS were present in 12,186 (7.5%) and 10,524 (6.5%) respectively. Both CA and CS were present in 3,965 (2.4%) patients. All cohorts were predominantly of male sex and white race (Table 1). Coronary angiography was used less frequently in CA + CS (62.2%) and CA only (60.2%) cohorts compared with the others 2 cohorts (68%). The CA + CS cohort had higher rates of noncardiac organ

Discussion

In the largest reported study evaluating the long-term outcomes of CA and CS complicating AMI, we noted several important findings: (1) 2.4% of all AMI patients had concomitant CA + CS, which was associated with an higher in-hospital mortality compared with CA or CS alone; (2) among patients that survive to hospital discharge, CS during the index admission, with or without concomitant CA, is associated with higher long-term mortality and MACCE, while CA alone is only associated with higher

Disclosures

All authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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    Funding: This analysis was funded by the Mayo Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery. This manuscript was written in partial fulfillment of requirements for the post-doctoral master's program (Dr. Vallabhajosyula). This program is funded by Clinical and Translational Science Award Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences, a component of the National Institutes of Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of National Institutes of Health.

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