Characteristics and Outcomes of Early vs Late Initiation of Mechanical Circulatory Support in Non-Acute Myocardial Infarction related Cardiogenic Shock: An Analysis of the National Inpatient Sample Database

Authors

Kirolos Barssoum, Department of cardiology, University of Texas Medical Branch, Galveston, TX.
Harsh P. Patel, Department cardiology, Southern Illinois University, Carbondale, IL.
Ramy Abdelmaseih, Department of cardiology, University of Texas Medical Branch, Galveston, TX.
Mohab Hassib, Department of cardiology, University of Texas Medical Branch, Galveston, TX.
Varun Victor, Canton Medical Education Foundation, Canton, OH.
Ahmed Mohamed, Department of cardiology, University of Texas Medical Branch, Galveston, TX.
Deaa Abu Jazar, Department of internal medicine, University of Texas Medical Branch, Galveston, TX.
Steven Mai, Department of internal medicine, University of Texas Medical Branch, Galveston, TX.
Fadi Ibrahim, American University of Antigua, Antigua & Barbuda.
Bhavin Patel, Department of internal medicine, Saint Joseph Mercy Oakland Hospital, Pontiac, MI.
Aiham El Baeni, Department of cardiology, University of Texas Medical Branch, Galveston, TX.
Wissam Khalife, Department of cardiology, University of Texas Medical Branch, Galveston, TX.
Dhrubjyoti Bandyopadhay, Department of Cardiology, Westchester Medical Center, Valhalla, NY.
Devesh Rai, Rochester Regional HealthFollow
Khaled Chatila, Department of cardiology, University of Texas Medical Branch, Galveston, TX.

Department

Cardiology

Document Type

Article

Publication Title

Current Problems in Cardiology

Abstract

Cardiogenic shock (CS) is significant cause of mortality. The use of mechanical circulatory support (MCS) in patients with non-acute myocardial infarction (Non-AMI) CS is lacking. We inquired data regarding the trends and outcomes early vs late initiation of MCS in non-AMI CS. We investigated National Inpatient Sample database between October 2015-December 2018, identifying hospitalizations with CS, either complicated by AMI or Non-AMI. Patients were divided into 2 cohorts, early initiation of MCS (< 48 hours) and late initiation of MCS (> 48 hours). The primary analysis included death within first 24 hours. A secondary analysis was adjusted after excluding patients who died in first 24 hours. A total of 85,318 patients with non-AMI-related CS with MCS placement were identified. Among this cohort, 54.6% (n=46,579) underwent early initiation of MCS within 48 hours, and 45.4% (n=38,739) underwent late initiation of MCS after 48 hours. In primary analysis, early MCS initiation was associated with more in-hospital mortality in primary outcome of all-cause hospital mortality (35.72% vs 27.63%, P< 0.0001, OR 1.44, 95% CI: 1.40-1.49, P< 0.0001), however, adjusted secondary analysis showed a statistically significant decrease in all-cause hospital mortality (23.63% vs 27.63%, P< 0.0001, OR 0.80, 95% CI: 0.78-0.83, P< 0.0001). In non-AMI-related CS and based on survival to 24 hours after admission, early initiation of MCS had statistically significant decrease in all-cause hospital mortality, with less incidence of vascular and renal complications, and shorter hospital stay. Late initiation of MCS was associated with a higher incidence of advanced therapies, including LVAD and transplant.

First Page

101584

DOI

10.1016/j.cpcardiol.2023.101584

Volume

48

Issue

5

Publication Date

5-1-2023

PubMed ID

36642353

Recommended Citation

Barssoum, K., Patel, H. P., Abdelmaseih, R., Hassib, M., Victor, V., Mohamed, A., Jazar, D. A., Mai, S., Ibrahim, F., Patel, B., Baeni, A. E., Khalife, W., Bandyopadhay, D., Rai, D., & Chatila, K. (2023). Characteristics and Outcomes of Early vs Late Initiation of Mechanical Circulatory Support in Non-Acute Myocardial Infarction related Cardiogenic Shock: An Analysis of the National Inpatient Sample Database. Current Problems in Cardiology, 48 (5), 101584. https://doi.org/10.1016/j.cpcardiol.2023.101584