Author + information
- Received November 17, 2018
- Revision received January 3, 2019
- Accepted January 8, 2019
- Published online April 8, 2019.
- Saraschandra Vallabhajosyula, MBBSa,b,∗ (, )@SarasVallabhMD@MayoClinic@MayoClinicCV@MayoPCCM,
- Shannon M. Dunlay, MD, MSa,c,
- Abhiram Prasad, MDa,
- Kianoush Kashani, MD, MSb,d,
- Ankit Sakhuja, MBBSe,
- Bernard J. Gersh, MBChB, DPhila,
- Allan S. Jaffe, MDa,
- David R. Holmes Jr., MDa and
- Gregory W. Barsness, MDa
- aDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- bDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
- cDepartment of Health Science Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
- dDivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota
- eDivision of Cardiovascular Critical Care, Department of Cardiovascular and Thoracic Surgery, West Virginia University School of Medicine, Morgantown, West Virginia
- ↵∗Address for correspondence:
Dr. Saraschandra Vallabhajosyula, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905.
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.
- acute myocardial infarction
- cardiac intensive care unit
- cardiogenic shock
- critical care cardiology
- National Inpatient Sample
- outcomes research
- renal failure
- respiratory failure
Dr. Jaffe has been a consultant for Beckman, Abbott, Siemens, ET Healthcare, Sphing6toec, Quidel, and Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received November 17, 2018.
- Revision received January 3, 2019.
- Accepted January 8, 2019.
- 2019 American College of Cardiology Foundation
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