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Racial Disparities in the Utilization and Outcomes of Temporary Mechanical Circulatory Support for Acute Myocardial Infarction-Cardiogenic Shock

Racial disparities in utilization and outcomes of mechanical circulatory support (MCS) in patients with acute myocardial infarction-cardiogenic shock (AMI-CS) are infrequently studied. This study sought to evaluate racial disparities in the outcomes of MCS in AMI-CS. The National Inpatient Sample (2...

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Autores principales: Vojjini, Rahul, Patlolla, Sri Harsha, Cheungpasitporn, Wisit, Kumar, Arnav, Sundaragiri, Pranathi R., Doshi, Rajkumar P., Jaffe, Allan S., Barsness, Gregory W., Holmes, David R., Rab, S. Tanveer, Vallabhajosyula, Saraschandra
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8037539/
https://www.ncbi.nlm.nih.gov/pubmed/33918132
http://dx.doi.org/10.3390/jcm10071459
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author Vojjini, Rahul
Patlolla, Sri Harsha
Cheungpasitporn, Wisit
Kumar, Arnav
Sundaragiri, Pranathi R.
Doshi, Rajkumar P.
Jaffe, Allan S.
Barsness, Gregory W.
Holmes, David R.
Rab, S. Tanveer
Vallabhajosyula, Saraschandra
author_facet Vojjini, Rahul
Patlolla, Sri Harsha
Cheungpasitporn, Wisit
Kumar, Arnav
Sundaragiri, Pranathi R.
Doshi, Rajkumar P.
Jaffe, Allan S.
Barsness, Gregory W.
Holmes, David R.
Rab, S. Tanveer
Vallabhajosyula, Saraschandra
author_sort Vojjini, Rahul
collection PubMed
description Racial disparities in utilization and outcomes of mechanical circulatory support (MCS) in patients with acute myocardial infarction-cardiogenic shock (AMI-CS) are infrequently studied. This study sought to evaluate racial disparities in the outcomes of MCS in AMI-CS. The National Inpatient Sample (2012–2017) was used to identify adult AMI-CS admissions receiving MCS support. MCS devices were classified as intra-aortic balloon pump (IABP), percutaneous left ventricular assist device (pLVAD) or extracorporeal membrane oxygenation (ECMO). Self-reported race was classified as white, black and others. Outcomes included in-hospital mortality, hospital length of stay and discharge disposition. During this period, 90,071 admissions were included with white, black and other races constituting 73.6%, 8.3% and 18.1%, respectively. Compared to white and other races, black race admissions were on average younger, female, with greater comorbidities, and non-cardiac organ failure (all p < 0.001). Compared to the white race (31.3%), in-hospital mortality was comparable in black (31.4%; adjusted odds ratio (aOR) 0.98 (95% confidence interval (CI) 0.93–1.05); p = 0.60) and other (30.2%; aOR 0.96 (95% CI 0.92–1.01); p = 0.10). Higher in-hospital mortality was noted in non-white races with concomitant cardiac arrest, and those receiving ECMO support. Black admissions had longer lengths of hospital stay (12.1 ± 14.2, 10.3 ± 11.2, 10.9 ± 1.2 days) and transferred less often (12.6%, 14.2%, 13.9%) compared to white and other races (both p < 0.001). In conclusion, this study of AMI-CS admissions receiving MCS devices did not identify racial disparities in in-hospital mortality. Black admissions had longer hospital stay and were transferred less often. Further evaluation with granular data including angiographic and hemodynamic parameters is essential to rule out racial differences.
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spelling pubmed-80375392021-04-12 Racial Disparities in the Utilization and Outcomes of Temporary Mechanical Circulatory Support for Acute Myocardial Infarction-Cardiogenic Shock Vojjini, Rahul Patlolla, Sri Harsha Cheungpasitporn, Wisit Kumar, Arnav Sundaragiri, Pranathi R. Doshi, Rajkumar P. Jaffe, Allan S. Barsness, Gregory W. Holmes, David R. Rab, S. Tanveer Vallabhajosyula, Saraschandra J Clin Med Article Racial disparities in utilization and outcomes of mechanical circulatory support (MCS) in patients with acute myocardial infarction-cardiogenic shock (AMI-CS) are infrequently studied. This study sought to evaluate racial disparities in the outcomes of MCS in AMI-CS. The National Inpatient Sample (2012–2017) was used to identify adult AMI-CS admissions receiving MCS support. MCS devices were classified as intra-aortic balloon pump (IABP), percutaneous left ventricular assist device (pLVAD) or extracorporeal membrane oxygenation (ECMO). Self-reported race was classified as white, black and others. Outcomes included in-hospital mortality, hospital length of stay and discharge disposition. During this period, 90,071 admissions were included with white, black and other races constituting 73.6%, 8.3% and 18.1%, respectively. Compared to white and other races, black race admissions were on average younger, female, with greater comorbidities, and non-cardiac organ failure (all p < 0.001). Compared to the white race (31.3%), in-hospital mortality was comparable in black (31.4%; adjusted odds ratio (aOR) 0.98 (95% confidence interval (CI) 0.93–1.05); p = 0.60) and other (30.2%; aOR 0.96 (95% CI 0.92–1.01); p = 0.10). Higher in-hospital mortality was noted in non-white races with concomitant cardiac arrest, and those receiving ECMO support. Black admissions had longer lengths of hospital stay (12.1 ± 14.2, 10.3 ± 11.2, 10.9 ± 1.2 days) and transferred less often (12.6%, 14.2%, 13.9%) compared to white and other races (both p < 0.001). In conclusion, this study of AMI-CS admissions receiving MCS devices did not identify racial disparities in in-hospital mortality. Black admissions had longer hospital stay and were transferred less often. Further evaluation with granular data including angiographic and hemodynamic parameters is essential to rule out racial differences. MDPI 2021-04-02 /pmc/articles/PMC8037539/ /pubmed/33918132 http://dx.doi.org/10.3390/jcm10071459 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/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 (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Vojjini, Rahul
Patlolla, Sri Harsha
Cheungpasitporn, Wisit
Kumar, Arnav
Sundaragiri, Pranathi R.
Doshi, Rajkumar P.
Jaffe, Allan S.
Barsness, Gregory W.
Holmes, David R.
Rab, S. Tanveer
Vallabhajosyula, Saraschandra
Racial Disparities in the Utilization and Outcomes of Temporary Mechanical Circulatory Support for Acute Myocardial Infarction-Cardiogenic Shock
title Racial Disparities in the Utilization and Outcomes of Temporary Mechanical Circulatory Support for Acute Myocardial Infarction-Cardiogenic Shock
title_full Racial Disparities in the Utilization and Outcomes of Temporary Mechanical Circulatory Support for Acute Myocardial Infarction-Cardiogenic Shock
title_fullStr Racial Disparities in the Utilization and Outcomes of Temporary Mechanical Circulatory Support for Acute Myocardial Infarction-Cardiogenic Shock
title_full_unstemmed Racial Disparities in the Utilization and Outcomes of Temporary Mechanical Circulatory Support for Acute Myocardial Infarction-Cardiogenic Shock
title_short Racial Disparities in the Utilization and Outcomes of Temporary Mechanical Circulatory Support for Acute Myocardial Infarction-Cardiogenic Shock
title_sort racial disparities in the utilization and outcomes of temporary mechanical circulatory support for acute myocardial infarction-cardiogenic shock
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8037539/
https://www.ncbi.nlm.nih.gov/pubmed/33918132
http://dx.doi.org/10.3390/jcm10071459
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