title: Trends in Coronary Angiography, Revascularization, and Outcomes of Cardiogenic Shock Complicating Non-ST-Elevation Myocardial Infarction.
abstract: Early revascularization is the mainstay of treatment for cardiogenic shock (CS) complicating acute myocardial infarction. However, data on the contemporary trends in management and outcomes of CS complicating non-ST-elevation myocardial infarction (NSTEMI) are limited. We used the 2006 to 2012 Nationwide Inpatient Sample databases to identify patients aged ≥ 18 years with NSTEMI with or without CS. Temporal trends and differences in coronary angiography, revascularization, and outcomes were analyzed. Of 2,191,772 patients with NSTEMI, 53,800 (2.5%) had a diagnosis of CS. From 2006 to 2012, coronary angiography rates increased from 53.6% to 60.4% in patients with NSTEMI with CS (ptrend <0.001). Among patients who underwent coronary angiography, revascularization rates were significantly higher in patients with CS versus without CS (72.5% vs 62.6%, p <0.001). Patients with NSTEMI with CS had significantly higher risk-adjusted in-hospital mortality (odds ratio 10.09, 95% confidence interval 9.88 to 10.32) as compared to those without CS. In patients with CS, an invasive strategy was associated with lower risk-adjusted in-hospital mortality (odds ratio 0.43, 95% confidence interval 0.42 to 0.45). Risk-adjusted in-hospital mortality, length of stay, and total hospital costs decreased over the study period in patients with and without CS (ptrend <0.001). In conclusion, we observed an increasing trend in coronary angiography and decreasing trend in in-hospital mortality, length of stay, and total hospital costs in patients with NSTEMI with and without CS. Despite these positive trends, overall coronary angiography and revascularization rates remain less than optimal and in-hospital mortality unacceptably high in patients with NSTEMI and CS.
authors.affiliation: Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York.
authors.forename: Dhaval
authors.initials: D
authors.lastname: Kolte
authors.affiliation: Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York.
authors.forename: Sahil
authors.initials: S
authors.lastname: Khera
authors.affiliation: Division of Cardiology, Department of Medicine, Rhode Island Hospital, Brown University, Providence, Rhode Island.
authors.forename: Kaustubh C
authors.initials: KC
authors.lastname: Dabhadkar
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Shikhar
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York.
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
authors.affiliation: Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York.
authors.forename: Robert
authors.initials: R
authors.lastname: Timmermans
authors.affiliation: Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York.
authors.forename: Diwakar
authors.initials: D
authors.lastname: Jain
authors.affiliation: Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York.
authors.forename: Howard A
authors.initials: HA
authors.lastname: Cooper
authors.affiliation: Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York.
authors.forename: William H
authors.initials: WH
authors.lastname: Frishman
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Venu
authors.initials: V
authors.lastname: Menon
authors.affiliation: Division of Cardiology, Department of Medicine, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: Division of Cardiology, Department of Medicine, Rhode Island Hospital, Brown University, Providence, Rhode Island.
authors.forename: J Dawn
authors.initials: JD
authors.lastname: Abbott
authors.affiliation: Division of Cardiology, Department of Medicine, David-Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York. Electronic address: Julio.Panza@wmchealth.org.
authors.forename: Julio A
authors.initials: JA
authors.lastname: Panza
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000639:trends*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D009204:Myocardial Revascularization / Q000639:trends*; D012042:Registries; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology