Clinical Research in Cardiology

, Volume 107, Issue 4, pp 287–303 | Cite as

Trends in mechanical circulatory support use and hospital mortality among patients with acute myocardial infarction and non-infarction related cardiogenic shock in the United States

  • Mahek Shah
  • Soumya Patnaik
  • Brijesh Patel
  • Pradhum Ram
  • Lohit Garg
  • Manyoo Agarwal
  • Sahil Agrawal
  • Shilpkumar Arora
  • Nilay Patel
  • Joyce Wald
  • Ulrich P. Jorde
Original Paper

Abstract

Background

Recent trends on outcomes in cardiogenic shock (CS) complicating acute myocardial infarction (AMI) suggest improvements in early survival. However, with the ever-changing landscape in management of CS, we sought to identify age-based trends in these outcomes and mechanical circulatory support (MCS) use among patients with both AMI and non-AMI associated shock.

Methods

We queried the 2005–2014 Nationwide Inpatient Sample databases to identify patients with a diagnosis of cardiogenic shock. Trends in the incidence of hospital-mortality, and use of MCS such as intra-aortic balloon pump (IABP), Impella/TandemHeart (IMP), and extra corporeal membrane oxygenation (ECMO) were analyzed within the overall population and among different age-categories (50 and under, 51–65, 66–80 and 81–99 years). We also made comparisons between patient groups admitted with CS complicating AMI and those with non-AMI associated CS.

Results

We studied 144,254 cases of CS, of which 55.4% cases were associated with an AMI. Between 2005 and 2014, an overall decline in IABP use (29.8–17.7%; ptrend < 0.01), and an uptrend in IMP use (0.1–2.6%; ptrend < 0.01), ECMO use (0.3–1.8%; ptrend < 0.01) and in-hospital mortality (44.1–52.5% AMI related, 49.6–53.5% non-AMI related; ptrend < 0.01) was seen. Patients aged 81–99 years had the lowest rate of MCS use (14.8%), whereas those aged 51–65 years had highest rate of MCS use (32.3%). Multivariable analysis revealed that patients aged 51-65 years (aOR 1.46, 95% CI 1.40–1.52; p<0.001), 66–80 years (aOR 2.51, 95% CI 2.39–2.63; p<0.01) and 81–99 years (aOR 5.04, 95% CI 4.78–5.32; p<0.01) had significantly higher hospital mortality compared to patients aged ≤ 50 years. Patients admitted with CS complicating AMI were older and had more comorbidities, but lower hospital mortality (45.0 vs. 48.2%; p < 0.001) when compared to non-AMI related CS. We also noted that the proportion of patients admitted with CS complicating AMI significantly decreased from 2005 to 2014 (65.3–45.6%; ptrend < 0.01) whereas those admitted without an associated AMI increased.

Conclusions

IABP use has declined whereas IMP and ECMO use has increased over time among CS admissions. Older age was associated with an incrementally higher independent risk for hospital mortality. Recent trends indicate an increase in both proportion of patients admitted with CS without associated AMI and in-hospital mortality across all CS admissions irrespective of AMI status.

Keywords

MCS Nationwide inpatient sample Cardiogenic shock Mortality Trends Balloon pump Impella ECMO 

Notes

Compliance with ethical standards

Funding sources

No study specific funding was used to support this work. The authors are solely responsible for the study design, conduct and analyses, drafting and editing of the manuscript and its final contents. All authors had access to the data and a role in writing the manuscript.

Disclosures

None of the authors has any disclosures relevant to the content of the manuscript.

Supplementary material

392_2017_1182_MOESM1_ESM.docx (35 kb)
Supplementary material 1 (DOCX 34 KB)

References

  1. 1.
    Thom T, Haase N, Rosamond W, Howard VJ, Rumsfeld J, Manolio T et al (2006) Heart disease and stroke statistics—2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 113(6):e85–e151CrossRefPubMedGoogle Scholar
  2. 2.
    Wayangankar SA, Bangalore S, McCoy LA, Jneid H, Latif F, Karrowni W et al (2016) Temporal trends and outcomes of patients undergoing percutaneous coronary interventions for cardiogenic shock in the setting of acute myocardial infarction: a report from the CathPCI Registry. JACC Cardiovasc Interv 9(4):341–351CrossRefPubMedGoogle Scholar
  3. 3.
    Babaev A1, Frederick PD, Pasta DJ, Every N, Sichrovsky T, Hochman JS (2005) NRMI Investigators. Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock. JAMA 294(4):448–454CrossRefPubMedGoogle Scholar
  4. 4.
    O’Gara P, Kushner F, Ascheim D, Casey D, Chung M, de Lemos J et al (2013) 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 127(4):e362–e245Google Scholar
  5. 5.
    Werdan K, Gielen S, Ebelt H, Hochman JS (2014) Mechanical circulatory support in cardiogenic shock. Eur Heart J 35(3):156–167CrossRefPubMedGoogle Scholar
  6. 6.
    O’Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA et al (2013) 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the American College of Emergency Physicians and Society for Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv 82(1):E1–27PubMedGoogle Scholar
  7. 7.
    Alexander KP, Newby LK, Armstrong PW, Cannon CP, Gibler WB, Rich MW et al (2007) Acute coronary care in the elderly, part II: ST-segment-elevation myocardial infarction: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation 115(19):2570–2589CrossRefPubMedGoogle Scholar
  8. 8.
    Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P et al (2011) Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 15(6):676–682 173CrossRefGoogle Scholar
  9. 9.
    Ouweneel DM, Eriksen E, Sjauw KD, van Dongen IM, Hirsch A, Packer EJ et al (2017) Percutaneous Mechanical Circulatory Support Versus Intra-Aortic Balloon Pump in Cardiogenic Shock After Acute Myocardial Infarction. J Am Coll Cardiol 24(3):278–287 69CrossRefGoogle Scholar
  10. 10.
    Agarwal S, Sud K, Martin J, Menon V (2015) Trends in the Use of Mechanical Circulatory Support Devices in Patients Presenting With ST-Segment Elevation Myocardial Infarction. JACC: Cardiovasc Interv 8(13):1772–1774Google Scholar
  11. 11.
    Sandhu A, McCoy L, Negi S, Atri P, Al’Aref S, Curtis J et al (2015) Use of mechanical circulatory support in patients undergoing percutaneous coronary intervention. Circulation 132(13):1243–1251CrossRefPubMedGoogle Scholar
  12. 12.
    Scheidt S, Wilner G, Mueller H, Summers D, Lesch M, Wolff G et al (1973) Intra-aortic balloon counterpulsation in cardiogenic shock—report of a cooperative clinical trial. N Engl J Med 288(19):979–984CrossRefPubMedGoogle Scholar
  13. 13.
    Unverzagt S, Buerke M, de Waha A, Haerting J, Pietzner D, Seyfarth M et al (2015) Intra-aortic balloon pump counterpulsation (IABP) for myocardial infarction complicated by cardiogenic shock. Cochrane Database Syst Rev.  https://doi.org/10.1002/14651858.CD007398.pub3 PubMedGoogle Scholar
  14. 14.
    Seyfarth M, Sibbing D, Bauer I, Fröhlich G, Bott-Flügel L, Byrne R et al (2008) A randomized clinical trial to evaluate the safety and efficacy of a percutaneous left ventricular assist device versus intra-aortic balloon pumping for treatment of cardiogenic shock caused by myocardial infarction. J Am Coll Cardiol 52(19):1584–1588CrossRefPubMedGoogle Scholar
  15. 15.
    Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J et al (2013) Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet 382(9905):1638–1645CrossRefPubMedGoogle Scholar
  16. 16.
    Wijns W, Kolh P, Danchin N, DiMario C, Falk V, Folliguet T et al (2010) Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 31(20):2501–2555CrossRefPubMedGoogle Scholar
  17. 17.
    Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V et al (2014) Authors/Task Force members. 2014 ESC/EACTS Guidelines on myocardial revascularization: the task force on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 35(37):2541–2619CrossRefPubMedGoogle Scholar
  18. 18.
    O’Gara PT, Kushner FG, Ascheim DD (2013) ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 62(11):485–510Google Scholar
  19. 19.
    Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B (2011) ACCF/AHA/SCAI guideline for percutaneous coronary intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 124(23):e574–e651CrossRefPubMedGoogle Scholar
  20. 20.
    Kolte D, Khera S, Aronow WS, Mujib M, Palaniswami C, Sule S et al (2014) Trends in incidence, management, and outcomes of cardiogenic shock complicating ST-elevation myocardial infarction in the United States. J Am Heart Assoc 3(1):e000590CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Goldberg RJ, Makam RCP, Yarzebski J, McManus DD, Lessard D, Gore JM (2016) Decade Long Trends (2001–2011) In the Incidence and Hospital Death Rates Associated with the In-Hospital Development of Cardiogenic Shock after Acute Myocardial Infarction: Goldberg et al: Cardiogenic Shock and AMI. Circulation Cardiovasc Qual Outcomes 9(2):117–125Google Scholar
  22. 22.
    Lindenauer PK, Lagu T, Shieh MS, Pekow PS, Rothberg MB (2012) Association of diagnostic coding with trends in hospitalizations and mortality of patients with pneumonia, 2003–2009. JAMA 307(13):1405–1413Google Scholar
  23. 23.
    Polgreen LA, Suneja M, Tang F, Carter BL, Polgreen PM (2015) Increasing trend in admissions for malignant hypertension and hypertensive encephalopathy in the United States. Hypertension 65(5):1002–1007CrossRefPubMedGoogle Scholar
  24. 24.
    Napp LC, Kühn C, Bauersachs J (2017) ECMO in cardiac arrest and cardiogenic shock. Herz 42(1):27–44CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Aso S, Matsui H, Fushimi K, Yasunaga H (2016) In-hospital mortality and successful weaning from venoarterial extracorporeal membrane oxygenation: analysis of 5263 patients using a national inpatient database in Japan. Crit Care 20:80CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Lauten A, Engström AE, Jung C, Empen K, Erne P, Cook S et al (2013) Percutaneous left-ventricular support with the Impella-2.5-assist device in acute cardiogenic shock: results of the Impella-EUROSHOCK-registry. Circ Heart Fail 6(1):23–30CrossRefPubMedGoogle Scholar
  27. 27.
    Khera R, Cram P, Lu X, Vyas A, Gerke A, Rosenthal G et al (2015) Trends in the Use of Percutaneous Ventricular Assist Devices: Analysis of National Inpatient Sample Data, 2007 Through 2012. JAMA Int Med 175(6):941–950Google Scholar
  28. 28.
    Prasad A, Lennon RJ, Rihal CS, Berger PB, Holmes DR Jr (2004) Outcomes of elderly patients with cardiogenic shock treated with early percutaneous revascularization. Am Heart J 147(6):1066–1070CrossRefPubMedGoogle Scholar
  29. 29.
    Aissaoui N, Puymirat E, Juilliere Y, Jourdain P, Blanchard D, Schiele F (2016) Fifteen-year trends in the management of cardiogenic shock and associated 1-year mortality in elderly patients with acute myocardial infarction: the FAST-MI programme. Eur J Heart Fail 18(9):1144–1152CrossRefPubMedGoogle Scholar
  30. 30.
    Alexander KP, Newby LK, Armstrong PW, Cannon CP, Gibler WB, Rich MW et al (2007) Acute coronary care in the elderly, part II: ST-segment-elevation myocardial infarction: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation 115(19):2570–2589CrossRefPubMedGoogle Scholar
  31. 31.
    Klein LW, Shaw RE, Krone RJ, Brindis RG, Anderson HV, Block PC et al (2005) Mortality after emergent percutaneous coronary intervention in cardiogenic shock secondary to acute myocardial infarction and usefulness of a mortality prediction model. Am J Cardiol 96(1):35–41CrossRefPubMedGoogle Scholar
  32. 32.
    Cheng JM, den Uil CA, Hoeks SE, van der Ent M, Jewbali LS, van Domburg RT, Serruys PW (2009) Percutaneous left ventricular assist devices vs. intra-aortic balloon pump counterpulsation for treatment of cardiogenic shock: a meta-analysis of controlled trials. Eur Heart J 30(17):2102–2108CrossRefPubMedGoogle Scholar
  33. 33.
    Thiele H, Sick P, Boudriot E, Diederich K, Hambrecht R, Niebauer J, Schuler G (2005) Randomized comparison of intra-aortic balloon support with a percutaneous left ventricular assist device in patients with revascularized acute myocardial infarction complicated by cardiogenic shock. Eur Heart J 26(13):1276–1283CrossRefPubMedGoogle Scholar
  34. 34.
    Shah AP, Retzer EM, Nathan S, Paul JD, Friant J, Dill KE, Thomas JL (2015) Clinical and economic effectiveness of percutaneous ventricular assist devices for high-risk patients undergoing percutaneous coronary intervention. J Invasive Cardiol 27(3):148–154PubMedGoogle Scholar
  35. 35.
    Gregory D, Scotti DJ, de Lissovoy G, Palacios I, Dion S, Maini B et al (2013) A Value-Based Analysis of Hemodynamic Support Strategies for High-Risk Heart Failure Patients Undergoing a Percutaneous Coronary Intervention. Am Health Drug Benefits 6(2):88–99PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Mahek Shah
    • 1
  • Soumya Patnaik
    • 2
  • Brijesh Patel
    • 1
  • Pradhum Ram
    • 2
  • Lohit Garg
    • 1
  • Manyoo Agarwal
    • 3
  • Sahil Agrawal
    • 4
  • Shilpkumar Arora
    • 5
  • Nilay Patel
    • 6
  • Joyce Wald
    • 7
  • Ulrich P. Jorde
    • 8
  1. 1.Department of CardiologyLehigh Valley Hospital NetworkAllentownUSA
  2. 2.Department of MedicineEinstein Medical CenterPhiladelphiaUSA
  3. 3.Department of MedicineUniversity of Tennessee Health Science CenterMemphisUSA
  4. 4.Department of CardiologySt. Luke’s University Health NetworkBethlehemUSA
  5. 5.Department of MedicineMount Sinai St Luke’s-Roosevelt HospitalNew YorkUSA
  6. 6.Department of MedicineSaint Peter’s University HospitalNew BrunswickUSA
  7. 7.Department of CardiologyHospital of University of PennsylvaniaPhiladelphiaUSA
  8. 8.Department of CardiologyMontefiore Medical CenterNew YorkUSA

Personalised recommendations