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...
Autores principales: | , , , , , , , , , , , |
---|---|
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 |