Acute respiratory failure and mechanical ventilation in cardiogenic shock complicating acute myocardial infarction in the USA, 2000-2014

Saraschandra Vallabhajosyula, Kianoush Kashani, Shannon M Dunlay, Shashaank Vallabhajosyula, Saarwaani Vallabhajosyula, Pranathi R Sundaragiri, Bernard J Gersh, Allan S Jaffe, Gregory W Barsness
Annals of Intensive Care 2019 August 28, 9 (1): 96

BACKGROUND: There are limited epidemiological data on acute respiratory failure (ARF) in cardiogenic shock complicating acute myocardial infarction (AMI-CS). This study sought to evaluate the prevalence and outcomes of ARF in AMI-CS.

METHODS: This was a retrospective study of AMI-CS admissions during 2000-2014 from the National Inpatient Sample. Administrative codes for ARF and mechanical ventilation (MV) were used to define the cohorts of no ARF, ARF without MV and ARF with MV. Admissions with a secondary diagnosis of AMI and with chronic MV were excluded. Outcomes of interest included in-hospital mortality, temporal trends of ARF prevalence and resource utilization.

MEASUREMENTS AND MAIN RESULTS: During 2000-2014, 439,436 admissions for AMI-CS met the inclusion criteria. ARF and MV were noted in 57% and 43%, respectively. Admissions with non-ST-elevation AMI-CS, of non-White race and with non-private insurance received MV more frequently. Noninvasive ventilation and invasive MV increased from 0.4% and 39.2% (2000) to 3.6% and 46.4% (2014), respectively (p < 0.001). Coronary angiography and percutaneous coronary intervention were used less frequently in admissions receiving ARF with MV. Compared to admissions with no ARF, ARF without MV (adjusted odds ratio (aOR) 1.56 [95% confidence interval (CI) 1.53-1.59]; p < 0.001) and ARF with MV (aOR 2.50 [95% CI 2.47-2.54]; p < 0.001) were associated with higher in-hospital mortality. Admissions with ARF without MV had greater resource utilization and lesser discharges to home as compared to no ARF.

CONCLUSIONS: In this contemporary AMI-CS cohort, the presence of ARF and MV use was noted in 57% and 43%, respectively, and was associated with higher in-hospital mortality.

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