Acute Noncardiac Organ Failure in Acute Myocardial Infarction With Cardiogenic Shock

Saraschandra Vallabhajosyula, Shannon M. Dunlay, Abhiram Prasad, Kianoush Kashani, Ankit Sakhuja, Bernard J. Gersh, Allan S. Jaffe, David R. Holmes, Gregory W. Barsness

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28 Scopus citations

Abstract

Background: There are limited data on acute noncardiac multiorgan failure in cardiogenic shock complicating acute myocardial infarction (AMI-CS). Objectives: The authors sought to evaluate the 15-year national trends, resource utilization, and outcomes of single and multiple noncardiac organ failures in AMI-CS. Methods: This was a retrospective cohort study of AMI-CS using the National Inpatient Sample database from 2000 to 2014. Previously validated codes for respiratory, renal, hepatic, hematologic, and neurological failure were used to identify single or multiorgan (≥2 organ systems) noncardiac organ failure. Outcomes of interest were in-hospital mortality, temporal trends, and resource utilization. The effects of every additional organ failure on in-hospital mortality and resource utilization were assessed. Results: In 444,253 AMI-CS admissions, noncardiac single or multiorgan failure was noted in 32.4% and 31.9%, respectively. Multiorgan failure was seen more commonly in admissions with non–ST-segment elevation AMI-CS, nonwhite race, and higher baseline comorbidity. There was a steady increase in the prevalence of single and multiorgan failure. Coronary angiography and revascularization were performed less commonly in multiorgan failure. Single-organ failure (odds ratio: 1.28; 95% confidence interval: 1.26 to 1.30) and multiorgan failure (odds ratio: 2.23; 95% confidence interval: 2.19 to 2.27) were independently associated with higher in-hospital mortality, greater resource utilization, and fewer discharges to home. There was a stepwise increase in in-hospital mortality and resource utilization with each additional organ failure. Conclusions: There has been a steady increase in the prevalence of multiorgan failure in AMI-CS. Presence of multiorgan failure was independently associated with higher in-hospital mortality and greater resource utilization.

Original languageEnglish (US)
Pages (from-to)1781-1791
Number of pages11
JournalJournal of the American College of Cardiology
Volume73
Issue number14
DOIs
StatePublished - Apr 16 2019

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Keywords

  • National Inpatient Sample
  • acute myocardial infarction
  • cardiac intensive care unit
  • cardiogenic shock
  • critical care cardiology
  • outcomes research
  • renal failure
  • respiratory failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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