The processes of care and long-term mortality of acute myocardial infarction with cardiogenic shock survivors: A nationwide cohort study.

Weight, Nicholas; Singh, Sandeep; Moledina, Saadiq; Mamas, Mamas A

Abstract

Acute myocardial infarction with cardiogenic shock (AMI-CS) carries a significant risk of inpatient mortality compared with AMI alone, although it is unclear what the longer-term outcomes of AMI-CS survivors is, and whether the inpatient quality of care received influences this. Using the Myocardial Ischaemia National Audit Project (MINAP) registry, linked to Office for National Statistics (ONS) mortality data, we analyzed 330,517 UK AMI patients; 3330 (1 %) with CS. Patients dying within thirty-days of admission were excluded. Median follow-up for patients included was 1642 days. Cox regression models were fitted, adjusting for demographics and management strategy. AMI-CS survivors were younger (median years) (67 vs. 69, p < 0.001), less often female (29 % vs. 32 %, p < 0.001) and more likely to present with STEMI (81 % vs. 37 %, p < 0.001). Mortality risk was highest at one-year for AMI-CS survivors compared to patients that did not suffer CS (adjusted hazard ratio [HR] 1.85; 95 % CI; 1.68-2.04, p < 0.001), and remained elevated at five-years (HR 1.55; 95 % CI; 1.43-1.68, p < 0.001). 'Excellent-care' according to mean opportunity-based quality indicator (OBQI) score compared to 'Poor-care', showed reduced risk of long-term mortality with AMI-CS (HR: 0.46, CI; 0.39-0.54, P < 0.001). Of patients that received "Excellent-care", AMI-CS survivors had elevated risk of long-term mortality (HR 1.45, 95 % CI; 1.34-1.57, P < 0.001). AMI-CS survivors have elevated risk long-term mortality risk when compared with AMI patients, which persists beyond five years. AMI-CS patients that receive higher-quality inpatient care have better longer-term survival compared to those with poorer inpatient care. [Abstract copyright: Copyright © 2024. Published by Elsevier B.V.]

Citation

Weight, N., Singh, S., Moledina, S., & Mamas, M. A. (in press). The processes of care and long-term mortality of acute myocardial infarction with cardiogenic shock survivors: A nationwide cohort study. International Journal of Cardiology, 419, Article 132669. https://doi.org/10.1016/j.ijcard.2024.132669

• Journal Article Type: Article
• Acceptance Date: Oct 20, 2024
• Online Publication Date: Oct 22, 2024
• Deposit Date: Nov 11, 2024
• Journal: International journal of cardiology
• Print ISSN: 0167-5273
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 419
• Article Number: 132669
• DOI: https://doi.org/10.1016/j.ijcard.2024.132669
• Keywords: Mortality, Acute myocardial infarction, Quality of care, And survival, Cardiogenic shock
• Public URL: https://keele-repository.worktribe.com/output/974331
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S0167527324012919?via%3Dihub