Dataset Information

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

ABSTRACT:

Aims

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 (AMI) 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 and results

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 healthcare resources. We estimated the association of MCS use, cardiovascular healthcare resources, and 30-day mortality. 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.

Conclusion

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.

SUBMITTER: Ishii M

PROVIDER: S-EPMC9242083 | biostudies-literature | 2022 Jan

REPOSITORIES: biostudies-literature

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Publications

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

Ishii Masanobu M Tsujita Kenichi K Okamoto Hiroshi H Koto Satoshi S Nishi Takeshi T Nakai Michikazu M Sumita Yoko Y Iwanaga Yoshitaka Y Azuma Nobuyoshi N Matoba Satoaki S Hirata Ken-Ichi KI Hikichi Yutaka Y Yokoi Hiroyoshi H Ikari Yuji Y Uemura Shiro S

European heart journal open 20211231 1

<h4>Aims</h4>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 (AMI) 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.<h4>Methods and results</h4>This wa ...[more]

PMID: 35919660

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Project description:AimsNorepinephrine is recommended as a first-line vasopressor agent in the haemodynamic stabilization of cardiogenic shock. The survival benefit of norepinephrine therapy has not been demonstrated in clinical practice, however. This study aimed to explore the relationship between norepinephrine use and outcomes in cardiogenic shock patients in real-world conditions.Methods and resultsWe conducted a retrospective cohort study based on the Medical Information Mart for Intensive Care III (MIMIC-III) database. Cardiogenic shock patients were enrolled and categorized into a norepinephrine group or a non-norepinephrine group. Propensity score matching (PSM) was used to control for confounders. Cox proportional-hazards models and multivariable logistic regression were used to investigate the relationship between norepinephrine treatment and mortality. A total of 927 eligible patients were included: 552 patients in the norepinephrine group and 375 patients in the non-norepinephrine group. After PSM, 222 cases from each group were matched using a 1:1 matching algorithm. Thirty day mortality for patients treated with norepinephrine was significantly higher than for those in the non-norepinephrine group (41% vs. 30%, OR 1.61, 95% CI 1.09-2.39, P = 0.017; HR 1.50, 95% CI 1.09-2.06, P = 0.013). In the multivariable analysis, there was no significant difference between norepinephrine therapy and long-term (90 day, 180 day, or 1 year) mortality (90 day (OR 1.19, 95% CI 0.82-1.74, P = 0.363), 180 day (OR 1.17, 95% CI 0.80-1.70, P = 0.418), 1 year (OR 1.14, 95% CI 0.79-1.66, P = 0.477). Patients in the norepinephrine group required more mechanical ventilation (84% vs. 67%, OR 2.67, 95% CI 1.70-4.25, P < 0.001) and experienced longer ICU stays (median 7 vs. 4 days, OR 7.92, 95% CI 1.40-44.83, P = 0.020) than non-norepinephrine group.ConclusionsCardiogenic shock patients treated with norepinephrine were associated with significantly increased short-term mortality, while no significant difference was found on long-term survival rates. Future trials are needed to validate and explore this association.

Dataset Information

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

Aims

Methods and results

Conclusion

Publications

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

Similar Datasets

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