Comparative analysis of cardiogenic shock outcomes in acute myocardial infarction with polyvascular disease

Gatuz, Marlon V.; Abu-Fanne, Rami; Abramov, Dmitry; Barel, Maguli; Mamas, Mamas A.; Roguin, Ariel; Kobo, Ofer

Abstract

Background
Cardiogenic shock (CS) is the leading cause of mortality in acute myocardial infarction (AMI) patients, especially in those with vascular disease. This study aimed to assess the association between extent of polyvascular disease and the in hospital management and outcome of patients with AMI-induced CS.
Method
Using the National Inpatient Sample from 2016 to 2019, adult patients with AMI and CS with known vascular disease were identified and stratified by number of diseased vascular beds and into STEMI and NSTEMI subgroups. The study assessed in-hospital major adverse cardiovascular and cerebrovascular events (MACCE), mortality, acute CVA and major bleeding, as well as invasive management by number of diseased vascular beds.
Results
Out of 136,245 patients, 57.9 % attributed to STEMI and 42.1 % to NSTEMI. The study revealed that the likelihood of percutaneous coronary intervention (PCI) [(aOR for 2 beds 0.94, CI 0.91–0.96, p-value < 0.001; 3 beds 1.0, CI 0.94–1.06, p-value 0.96)] and coronary artery bypass grafting (CABG) [(aOR for 2 beds 0.66, CI 0.64–0.69, p-value < 0.001; 3 beds 0.76, CI 0.71–0.81, p-value < 0.001)] decreased as the number of diseased vascular sites increased. The study also highlighted a direct dose-response relationship between the number of diseased vascular beds and major adverse outcomes, including MACCE, mortality and acute CVA, underscoring the prognostic significance of polyvascular disease in this patient population.
Conclusion
The study demonstrated that polyvascular disease significantly worsens AMI-induced CS outcomes. The findings highlight the importance of early identification and aggressive management of polyvascular disease in these patients. Further research is needed to develop targeted treatment strategies for this high-risk population.

Citation

Gatuz, M. V., Abu-Fanne, R., Abramov, D., Barel, M., Mamas, M. A., Roguin, A., & Kobo, O. (2024). Comparative analysis of cardiogenic shock outcomes in acute myocardial infarction with polyvascular disease. American Heart Journal Plus: Cardiology Research and Practice, 46, Article 100452. https://doi.org/10.1016/j.ahjo.2024.100452

• Journal Article Type: Article
• Acceptance Date: Aug 28, 2024
• Online Publication Date: Sep 2, 2024
• Publication Date: 2024-10
• Deposit Date: Sep 27, 2024
• Journal: American Heart Journal Plus: Cardiology Research and Practice
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 46
• Article Number: 100452
• DOI: https://doi.org/10.1016/j.ahjo.2024.100452
• Keywords: Cardiogenic shock; Poly-vascular disease; Acute myocardial infarction; Outcomes
• Public URL: https://keele-repository.worktribe.com/output/926153
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S2666602224000958?via%3Dihub
• Additional Information: This article is maintained by: Elsevier; Article Title: Comparative analysis of cardiogenic shock outcomes in acute myocardial infarction with polyvascular disease; Journal Title: American Heart Journal Plus: Cardiology Research and Practice; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.ahjo.2024.100452; Content Type: article; Copyright: © 2024 The Authors. Published by Elsevier Inc.