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Temporal Trends and Outcomes of Patients Undergoing Percutaneous Coronary Interventions for Cardiogenic Shock in the Setting of Acute Myocardial Infarction: A Report From the CathPCI Registry.
JACC Cardiovasc Interv. 2016 Feb 22; 9(4):341-351.JC

Abstract

OBJECTIVES

The purpose of this study was to examine the temporal trends in demographics, clinical characteristics, management strategies, and in-hospital outcomes in patients with acute myocardial infarction complicated by cardiogenic shock (CS-AMI) who underwent percutaneous coronary intervention (PCI) from the Cath-PCI Registry (2005 to 2013).

BACKGROUND

The authors examined contemporary use and outcomes of PCI in patients with CS-AMI.

METHODS

The authors used the Cath-PCI Registry to evaluate 56,497 patients (January 2005 to December 2013) undergoing PCI for CS-AMI. Temporal trends in clinical variables and outcomes were assessed.

RESULTS

Compared with cases performed from 2005 to 2006, CS-AMI patients receiving PCI from 2011 to 2013 were more likely to have diabetes, hypertension, dyslipidemia, previous PCI, dialysis, but less likely to have chronic lung disease, peripheral vascular disease, or heart failure within 2 weeks (p < 0.01). Between 2005 and 2006 to 2011 and 2013, intra-aortic balloon pump use decreased (49.5% to 44.9%; p < 0.01), drug-eluting stent use declined (65% to 46%; p < 0.01), and the use of bivalirudin increased (12.6% to 45.6%). Adjusted in-hospital mortality; increased (27.6% in 2005 to 2006 vs. 30.6% in 2011 to 2013, adjusted odds ratio: 1.09, 95% confidence interval: 1.005 to .173; p = 0.04) for patients who were managed with an early invasive strategy (<24 h from symptoms).

CONCLUSIONS

Our study shows that despite the evolution of medical technology and use of contemporary therapeutic measures, in-hospital mortality in CS-AMI patients who are managed invasively continues to rise. Additional research and targeted efforts are indicated to improve outcomes in this high-risk cohort.

Authors+Show Affiliations

Cleveland Clinic, Cleveland, Ohio. Electronic address: wayangs@ccf.org.New York University School of Medicine, New York, New York.Duke Clinical Research Institute, Durham, North Carolina.Baylor College of Medicine, Houston, Texas.Health Sciences Center and Veterans Affairs Medical Center, University of Oklahoma, Oklahoma City, Oklahoma.UnityPoint Clinic Cardiology, Cedar Rapid, Iowa.Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York.Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York.American University of Beirut, Beirut, Lebanon.Brigham and Women's Hospital, Boston, Massachusetts.Duke Clinical Research Institute, Durham, North Carolina.School of Medicine, University of Colorado, Denver, Colorado.Duke Clinical Research Institute, Durham, North Carolina.Health Sciences Center, Texas Tech University, El Paso, Texas.St. Louis VA Medical Center, and Department of Internal Medicine, School of Medicine, Saint Louis University, Saint Louis, Missouri.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26803418

Citation

Wayangankar, Siddharth A., et al. "Temporal Trends and Outcomes of Patients Undergoing Percutaneous Coronary Interventions for Cardiogenic Shock in the Setting of Acute Myocardial Infarction: a Report From the CathPCI Registry." JACC. Cardiovascular Interventions, vol. 9, no. 4, 2016, pp. 341-351.
Wayangankar SA, Bangalore S, McCoy LA, et al. Temporal Trends and Outcomes of Patients Undergoing Percutaneous Coronary Interventions for Cardiogenic Shock in the Setting of Acute Myocardial Infarction: A Report From the CathPCI Registry. JACC Cardiovasc Interv. 2016;9(4):341-351.
Wayangankar, S. A., Bangalore, S., McCoy, L. A., Jneid, H., Latif, F., Karrowni, W., Charitakis, K., Feldman, D. N., Dakik, H. A., Mauri, L., Peterson, E. D., Messenger, J., Roe, M., Mukherjee, D., & Klein, A. (2016). Temporal Trends and Outcomes of Patients Undergoing Percutaneous Coronary Interventions for Cardiogenic Shock in the Setting of Acute Myocardial Infarction: A Report From the CathPCI Registry. JACC. Cardiovascular Interventions, 9(4), 341-351. https://doi.org/10.1016/j.jcin.2015.10.039
Wayangankar SA, et al. Temporal Trends and Outcomes of Patients Undergoing Percutaneous Coronary Interventions for Cardiogenic Shock in the Setting of Acute Myocardial Infarction: a Report From the CathPCI Registry. JACC Cardiovasc Interv. 2016 Feb 22;9(4):341-351. PubMed PMID: 26803418.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Temporal Trends and Outcomes of Patients Undergoing Percutaneous Coronary Interventions for Cardiogenic Shock in the Setting of Acute Myocardial Infarction: A Report From the CathPCI Registry. AU - Wayangankar,Siddharth A, AU - Bangalore,Sripal, AU - McCoy,Lisa A, AU - Jneid,Hani, AU - Latif,Faisal, AU - Karrowni,Wassef, AU - Charitakis,Konstantinos, AU - Feldman,Dmitriy N, AU - Dakik,Habib A, AU - Mauri,Laura, AU - Peterson,Eric D, AU - Messenger,John, AU - Roe,Mathew, AU - Mukherjee,Debabrata, AU - Klein,Andrew, Y1 - 2016/01/20/ PY - 2015/07/20/received PY - 2015/09/17/revised PY - 2015/10/24/accepted PY - 2016/1/25/entrez PY - 2016/1/25/pubmed PY - 2016/12/15/medline KW - acute coronary syndrome(s) KW - acute myocardial infarction KW - cardiogenic shock KW - percutaneous coronary intervention SP - 341 EP - 351 JF - JACC. Cardiovascular interventions JO - JACC Cardiovasc Interv VL - 9 IS - 4 N2 - OBJECTIVES: The purpose of this study was to examine the temporal trends in demographics, clinical characteristics, management strategies, and in-hospital outcomes in patients with acute myocardial infarction complicated by cardiogenic shock (CS-AMI) who underwent percutaneous coronary intervention (PCI) from the Cath-PCI Registry (2005 to 2013). BACKGROUND: The authors examined contemporary use and outcomes of PCI in patients with CS-AMI. METHODS: The authors used the Cath-PCI Registry to evaluate 56,497 patients (January 2005 to December 2013) undergoing PCI for CS-AMI. Temporal trends in clinical variables and outcomes were assessed. RESULTS: Compared with cases performed from 2005 to 2006, CS-AMI patients receiving PCI from 2011 to 2013 were more likely to have diabetes, hypertension, dyslipidemia, previous PCI, dialysis, but less likely to have chronic lung disease, peripheral vascular disease, or heart failure within 2 weeks (p < 0.01). Between 2005 and 2006 to 2011 and 2013, intra-aortic balloon pump use decreased (49.5% to 44.9%; p < 0.01), drug-eluting stent use declined (65% to 46%; p < 0.01), and the use of bivalirudin increased (12.6% to 45.6%). Adjusted in-hospital mortality; increased (27.6% in 2005 to 2006 vs. 30.6% in 2011 to 2013, adjusted odds ratio: 1.09, 95% confidence interval: 1.005 to .173; p = 0.04) for patients who were managed with an early invasive strategy (<24 h from symptoms). CONCLUSIONS: Our study shows that despite the evolution of medical technology and use of contemporary therapeutic measures, in-hospital mortality in CS-AMI patients who are managed invasively continues to rise. Additional research and targeted efforts are indicated to improve outcomes in this high-risk cohort. SN - 1876-7605 UR - https://www.unboundmedicine.com/medline/citation/26803418/Temporal_Trends_and_Outcomes_of_Patients_Undergoing_Percutaneous_Coronary_Interventions_for_Cardiogenic_Shock_in_the_Setting_of_Acute_Myocardial_Infarction:_A_Report_From_the_CathPCI_Registry_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1936-8798(15)01699-4 DB - PRIME DP - Unbound Medicine ER -