Cargando…

Contemporary National Outcomes of Acute Myocardial Infarction-Cardiogenic Shock in Patients with Prior Chronic Kidney Disease and End-Stage Renal Disease

Background: There are limited data on acute myocardial infarction with cardiogenic shock (AMI-CS) stratified by chronic kidney disease (CKD) stages. Objective: To assess clinical outcomes in AMI-CS stratified by CKD stages. Methods: A retrospective cohort of AMI-CS during 2005–2016 from the National...

Descripción completa

Detalles Bibliográficos
Autores principales: Vallabhajosyula, Saraschandra, Ya’Qoub, Lina, Kumar, Vinayak, Verghese, Dhiran, Subramaniam, Anna V., Patlolla, Sri Harsha, Desai, Viral K., Sundaragiri, Pranathi R., Cheungpasitporn, Wisit, Deshmukh, Abhishek J., Kashani, Kianoush, Barsness, Gregory W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7698908/
https://www.ncbi.nlm.nih.gov/pubmed/33218121
http://dx.doi.org/10.3390/jcm9113702
_version_ 1783615933634314240
author Vallabhajosyula, Saraschandra
Ya’Qoub, Lina
Kumar, Vinayak
Verghese, Dhiran
Subramaniam, Anna V.
Patlolla, Sri Harsha
Desai, Viral K.
Sundaragiri, Pranathi R.
Cheungpasitporn, Wisit
Deshmukh, Abhishek J.
Kashani, Kianoush
Barsness, Gregory W.
author_facet Vallabhajosyula, Saraschandra
Ya’Qoub, Lina
Kumar, Vinayak
Verghese, Dhiran
Subramaniam, Anna V.
Patlolla, Sri Harsha
Desai, Viral K.
Sundaragiri, Pranathi R.
Cheungpasitporn, Wisit
Deshmukh, Abhishek J.
Kashani, Kianoush
Barsness, Gregory W.
author_sort Vallabhajosyula, Saraschandra
collection PubMed
description Background: There are limited data on acute myocardial infarction with cardiogenic shock (AMI-CS) stratified by chronic kidney disease (CKD) stages. Objective: To assess clinical outcomes in AMI-CS stratified by CKD stages. Methods: A retrospective cohort of AMI-CS during 2005–2016 from the National Inpatient Sample was categorized as no CKD, CKD stage-III (CKD-III), CKD stage-IV (CKD-IV) and end-stage renal disease (ESRD). CKD-I/II were excluded. Outcomes included in-hospital mortality, use of coronary angiography, percutaneous coronary intervention (PCI) and mechanical circulatory support (MCS). We also evaluated acute kidney injury (AKI) and acute hemodialysis in non-ESRD admissions. Results: Of 372,412 AMI-CS admissions, CKD-III, CKD-IV and ESRD comprised 20,380 (5.5%), 7367 (2.0%) and 18,109 (4.9%), respectively. Admissions with CKD were, on average, older, of the White race, bearing Medicare insurance, of a lower socioeconomic stratum, with higher comorbidities, and higher rates of acute organ failure. Compared to the cohort without CKD, CKD-III, CKD-IV and ESRD had lower use of coronary angiography (72.7%, 67.1%, 56.9%, 61.1%), PCI (53.7%, 43.8%, 38.4%, 37.6%) and MCS (47.9%, 38.3%, 33.3%, 34.2%), respectively (all p < 0.001). AKI and acute hemodialysis use increased with increase in CKD stage (no CKD–38.5%, 2.6%; CKD-III–79.1%, 6.5%; CKD-IV–84.3%, 12.3%; p < 0.001). ESRD (adjusted odds ratio [OR] 1.25 [95% confidence interval {CI} 1.21–1.31]; p < 0.001), but not CKD-III (OR 0.72 [95% CI 0.69–0.75); p < 0.001) or CKD-IV (OR 0.82 [95 CI 0.77–0.87] was predictive of in-hospital mortality. Conclusions: CKD/ESRD is associated with lower use of evidence-based therapies. ESRD was an independent predictor of higher in-hospital mortality in AMI-CS.
format Online
Article
Text
id pubmed-7698908
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-76989082020-11-29 Contemporary National Outcomes of Acute Myocardial Infarction-Cardiogenic Shock in Patients with Prior Chronic Kidney Disease and End-Stage Renal Disease Vallabhajosyula, Saraschandra Ya’Qoub, Lina Kumar, Vinayak Verghese, Dhiran Subramaniam, Anna V. Patlolla, Sri Harsha Desai, Viral K. Sundaragiri, Pranathi R. Cheungpasitporn, Wisit Deshmukh, Abhishek J. Kashani, Kianoush Barsness, Gregory W. J Clin Med Article Background: There are limited data on acute myocardial infarction with cardiogenic shock (AMI-CS) stratified by chronic kidney disease (CKD) stages. Objective: To assess clinical outcomes in AMI-CS stratified by CKD stages. Methods: A retrospective cohort of AMI-CS during 2005–2016 from the National Inpatient Sample was categorized as no CKD, CKD stage-III (CKD-III), CKD stage-IV (CKD-IV) and end-stage renal disease (ESRD). CKD-I/II were excluded. Outcomes included in-hospital mortality, use of coronary angiography, percutaneous coronary intervention (PCI) and mechanical circulatory support (MCS). We also evaluated acute kidney injury (AKI) and acute hemodialysis in non-ESRD admissions. Results: Of 372,412 AMI-CS admissions, CKD-III, CKD-IV and ESRD comprised 20,380 (5.5%), 7367 (2.0%) and 18,109 (4.9%), respectively. Admissions with CKD were, on average, older, of the White race, bearing Medicare insurance, of a lower socioeconomic stratum, with higher comorbidities, and higher rates of acute organ failure. Compared to the cohort without CKD, CKD-III, CKD-IV and ESRD had lower use of coronary angiography (72.7%, 67.1%, 56.9%, 61.1%), PCI (53.7%, 43.8%, 38.4%, 37.6%) and MCS (47.9%, 38.3%, 33.3%, 34.2%), respectively (all p < 0.001). AKI and acute hemodialysis use increased with increase in CKD stage (no CKD–38.5%, 2.6%; CKD-III–79.1%, 6.5%; CKD-IV–84.3%, 12.3%; p < 0.001). ESRD (adjusted odds ratio [OR] 1.25 [95% confidence interval {CI} 1.21–1.31]; p < 0.001), but not CKD-III (OR 0.72 [95% CI 0.69–0.75); p < 0.001) or CKD-IV (OR 0.82 [95 CI 0.77–0.87] was predictive of in-hospital mortality. Conclusions: CKD/ESRD is associated with lower use of evidence-based therapies. ESRD was an independent predictor of higher in-hospital mortality in AMI-CS. MDPI 2020-11-18 /pmc/articles/PMC7698908/ /pubmed/33218121 http://dx.doi.org/10.3390/jcm9113702 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Vallabhajosyula, Saraschandra
Ya’Qoub, Lina
Kumar, Vinayak
Verghese, Dhiran
Subramaniam, Anna V.
Patlolla, Sri Harsha
Desai, Viral K.
Sundaragiri, Pranathi R.
Cheungpasitporn, Wisit
Deshmukh, Abhishek J.
Kashani, Kianoush
Barsness, Gregory W.
Contemporary National Outcomes of Acute Myocardial Infarction-Cardiogenic Shock in Patients with Prior Chronic Kidney Disease and End-Stage Renal Disease
title Contemporary National Outcomes of Acute Myocardial Infarction-Cardiogenic Shock in Patients with Prior Chronic Kidney Disease and End-Stage Renal Disease
title_full Contemporary National Outcomes of Acute Myocardial Infarction-Cardiogenic Shock in Patients with Prior Chronic Kidney Disease and End-Stage Renal Disease
title_fullStr Contemporary National Outcomes of Acute Myocardial Infarction-Cardiogenic Shock in Patients with Prior Chronic Kidney Disease and End-Stage Renal Disease
title_full_unstemmed Contemporary National Outcomes of Acute Myocardial Infarction-Cardiogenic Shock in Patients with Prior Chronic Kidney Disease and End-Stage Renal Disease
title_short Contemporary National Outcomes of Acute Myocardial Infarction-Cardiogenic Shock in Patients with Prior Chronic Kidney Disease and End-Stage Renal Disease
title_sort contemporary national outcomes of acute myocardial infarction-cardiogenic shock in patients with prior chronic kidney disease and end-stage renal disease
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7698908/
https://www.ncbi.nlm.nih.gov/pubmed/33218121
http://dx.doi.org/10.3390/jcm9113702
work_keys_str_mv AT vallabhajosyulasaraschandra contemporarynationaloutcomesofacutemyocardialinfarctioncardiogenicshockinpatientswithpriorchronickidneydiseaseandendstagerenaldisease
AT yaqoublina contemporarynationaloutcomesofacutemyocardialinfarctioncardiogenicshockinpatientswithpriorchronickidneydiseaseandendstagerenaldisease
AT kumarvinayak contemporarynationaloutcomesofacutemyocardialinfarctioncardiogenicshockinpatientswithpriorchronickidneydiseaseandendstagerenaldisease
AT verghesedhiran contemporarynationaloutcomesofacutemyocardialinfarctioncardiogenicshockinpatientswithpriorchronickidneydiseaseandendstagerenaldisease
AT subramaniamannav contemporarynationaloutcomesofacutemyocardialinfarctioncardiogenicshockinpatientswithpriorchronickidneydiseaseandendstagerenaldisease
AT patlollasriharsha contemporarynationaloutcomesofacutemyocardialinfarctioncardiogenicshockinpatientswithpriorchronickidneydiseaseandendstagerenaldisease
AT desaiviralk contemporarynationaloutcomesofacutemyocardialinfarctioncardiogenicshockinpatientswithpriorchronickidneydiseaseandendstagerenaldisease
AT sundaragiripranathir contemporarynationaloutcomesofacutemyocardialinfarctioncardiogenicshockinpatientswithpriorchronickidneydiseaseandendstagerenaldisease
AT cheungpasitpornwisit contemporarynationaloutcomesofacutemyocardialinfarctioncardiogenicshockinpatientswithpriorchronickidneydiseaseandendstagerenaldisease
AT deshmukhabhishekj contemporarynationaloutcomesofacutemyocardialinfarctioncardiogenicshockinpatientswithpriorchronickidneydiseaseandendstagerenaldisease
AT kashanikianoush contemporarynationaloutcomesofacutemyocardialinfarctioncardiogenicshockinpatientswithpriorchronickidneydiseaseandendstagerenaldisease
AT barsnessgregoryw contemporarynationaloutcomesofacutemyocardialinfarctioncardiogenicshockinpatientswithpriorchronickidneydiseaseandendstagerenaldisease