Comparison of in-hospital outcomes of ST-elevation myocardial infarction patients with cardiogenic shock receiving left ventricular mechanical circulatory support devices based on transfer status

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions Pub Date : 2024-07-31 DOI:10.1002/ccd.31169

Mukunthan Murthi MD, Naveen Prasath MD, Anisha Memdani MD, Aniesh Bobba MD, Laith Ali MD, Steve Attanasio MD

{"title":"Comparison of in-hospital outcomes of ST-elevation myocardial infarction patients with cardiogenic shock receiving left ventricular mechanical circulatory support devices based on transfer status","authors":"Mukunthan Murthi MD, Naveen Prasath MD, Anisha Memdani MD, Aniesh Bobba MD, Laith Ali MD, Steve Attanasio MD","doi":"10.1002/ccd.31169","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>We aimed to compare outcomes in patients who receive on-site left ventricular mechanical support versus those transferred to other facilities for mechanical support in ST-elevation myocardial infarction (STEMI) patients with cardiogenic shock.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This retrospective study analyzed data from the 2016 to 2020 Nationwide Inpatient Sample (NIS) database. We identified patients with STEMI and cardiogenic shock who received Impella and LVAD placement during their hospital stay. They were divided into two groups: those with in-house (direct) placement and those transferred to higher-level medical centers. The primary goal was to compare mortality rates between these groups.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>During the study, 15,934 (75.2%) received in-house left ventricular support, while 5255 (24.8%) were transferred. Mean age (63 vs. 64 years) and female percentage (25 vs. 26%) were similar. The average time from admission to receiving LV support was 0.8 days for direct group versus 2.8 days for transfer group (<i>p</i> < 0.001). Transferred patients had a higher rate of prior heart failure (68 vs. 79%, <i>p</i> < 0.001) and peripheral vascular disease (10 vs. 14%, <i>p</i> < 0.001) but a lower rate of hypertension (23 vs. 17%, <i>p</i> = 0.003). There were no significant differences in other comorbidities. Primary outcome mortality did not significantly differ (44.9 vs. 44.2, <i>p</i> = 0.66). After multivariate analysis, transferred patients had higher rates of ECMO usage, acute kidney injury, renal replacement therapy, major bleeding, and ischemic stroke. Length of stay (8 vs. 15 days, <i>p</i> < 0.001) and total charges ($391,472 vs. $581,183, <i>p</i> < 0.001) were significantly higher in the transferred group.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Among STEMI patients with cardiogenic shock, our study found no significant difference in mortality between patients transferred for and those with on-site LV support. Those transferred patients experienced more complications, longer length of stay, and increased hospital costs.</p>\n </section>\n </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":null,"pages":null},"PeriodicalIF":2.1000,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Catheterization and Cardiovascular Interventions","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/ccd.31169","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background

We aimed to compare outcomes in patients who receive on-site left ventricular mechanical support versus those transferred to other facilities for mechanical support in ST-elevation myocardial infarction (STEMI) patients with cardiogenic shock.

Methods

This retrospective study analyzed data from the 2016 to 2020 Nationwide Inpatient Sample (NIS) database. We identified patients with STEMI and cardiogenic shock who received Impella and LVAD placement during their hospital stay. They were divided into two groups: those with in-house (direct) placement and those transferred to higher-level medical centers. The primary goal was to compare mortality rates between these groups.

Results

During the study, 15,934 (75.2%) received in-house left ventricular support, while 5255 (24.8%) were transferred. Mean age (63 vs. 64 years) and female percentage (25 vs. 26%) were similar. The average time from admission to receiving LV support was 0.8 days for direct group versus 2.8 days for transfer group (p < 0.001). Transferred patients had a higher rate of prior heart failure (68 vs. 79%, p < 0.001) and peripheral vascular disease (10 vs. 14%, p < 0.001) but a lower rate of hypertension (23 vs. 17%, p = 0.003). There were no significant differences in other comorbidities. Primary outcome mortality did not significantly differ (44.9 vs. 44.2, p = 0.66). After multivariate analysis, transferred patients had higher rates of ECMO usage, acute kidney injury, renal replacement therapy, major bleeding, and ischemic stroke. Length of stay (8 vs. 15 days, p < 0.001) and total charges ($391,472 vs. $581,183, p < 0.001) were significantly higher in the transferred group.

Conclusion

Among STEMI patients with cardiogenic shock, our study found no significant difference in mortality between patients transferred for and those with on-site LV support. Those transferred patients experienced more complications, longer length of stay, and increased hospital costs.

查看原文本刊更多论文

根据转院情况比较接受左心室机械循环支持装置的ST段抬高心肌梗死心源性休克患者的院内预后。

背景：我们旨在比较ST段抬高型心肌梗死（STEMI）心源性休克患者接受现场左心室机械支持与转至其他机构接受机械支持的患者的预后：这项回顾性研究分析了2016年至2020年全国住院患者样本（NIS）数据库中的数据。我们确定了在住院期间接受 Impella 和 LVAD 植入的 STEMI 和心源性休克患者。他们被分为两组：内部（直接）置入者和转至上级医疗中心者。主要目的是比较这两组患者的死亡率：研究期间，15934 人（75.2%）接受了内部左心室支持，5255 人（24.8%）接受了转院。平均年龄（63 岁对 64 岁）和女性比例（25% 对 26%）相似。直接组患者从入院到接受左心室支持的平均时间为 0.8 天，而转运组为 2.8 天（P 结论：直接组患者从入院到接受左心室支持的平均时间为 0.8 天，而转运组为 2.8 天：在心源性休克的 STEMI 患者中，我们的研究发现，转院接受左心室支持的患者与现场接受左心室支持的患者在死亡率上没有明显差异。转院患者的并发症更多，住院时间更长，住院费用增加。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.