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Post-Hospital Outcomes of Patients With Acute Myocardial Infarction With Cardiogenic Shock: Findings From the NCDR.

Publication ,  Journal Article
Shah, RU; de Lemos, JA; Wang, TY; Chen, AY; Thomas, L; Sutton, NR; Fang, JC; Scirica, BM; Henry, TD; Granger, CB
Published in: J Am Coll Cardiol
February 23, 2016

BACKGROUND: Many patients with acute myocardial infarction (AMI) and cardiogenic shock survive hospitalization; little is known about their subsequent prognosis. OBJECTIVES: This study sought to evaluate the associations between cardiogenic shock and post-discharge mortality and all-cause hospitalization among hospital survivors. METHODS: We included patients ≥65 years of age with AMI from the ACTION Registry-GWTG (Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines) who survived hospitalization and linked these patients with Medicare claims data. We used proportional hazards models to test the association between cardiogenic shock and outcomes, adjusting for patient and hospital characteristics. Hazard ratios (HRs) are reported for early (1 to 60 days) and late (61 to 365 days) post-discharge time periods. RESULTS: Among 112,668 AMI survivors, 5% had cardiogenic shock during hospitalization. The rate of death was significantly higher among patients with cardiogenic shock at 60 days (9.6% vs. 5.5%) and 1 year (22.4% vs. 16.7%). After accounting for baseline characteristics, the risk of death remained higher for cardiogenic shock patients in the first 60 days after discharge (adjusted HR: 1.62; 95% confidence interval [CI]: 1.46 to 1.80), but was similar to nonshock patients thereafter (adjusted HR: 1.08 for days 61 to 365; 95% CI: 1.00 to 1.18). The rate of all-cause hospitalization or death was significantly higher among shock patients at 60 days (33.9% vs. 24.9%) and 1 year (59.1% vs. 52.3%). After adjustment, the risk of this outcome was also clustered in the first 60 days (adjusted HR: 1.28; 95% CI: 1.21 to 1.35) and was similar thereafter (adjusted HR: 0.95 for days 61 to 365; 95% CI: 0.89 to 1.01). CONCLUSIONS: Hospital survivors of AMI who had cardiogenic shock have a higher risk of death and/or hospitalization during the first year after discharge. The risk is time-dependent and is clustered in the early post-discharge period, after which the prognosis is similar in patients with and without cardiogenic shock.

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

February 23, 2016

Volume

67

Issue

7

Start / End Page

739 / 747

Location

United States

Related Subject Headings

  • United States
  • Time Factors
  • Survival Rate
  • Shock, Cardiogenic
  • Risk Assessment
  • Retrospective Studies
  • Registries
  • Prognosis
  • Patient Discharge
  • Myocardial Infarction
 

Citation

APA
Chicago
ICMJE
MLA
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Shah, R. U., de Lemos, J. A., Wang, T. Y., Chen, A. Y., Thomas, L., Sutton, N. R., … Granger, C. B. (2016). Post-Hospital Outcomes of Patients With Acute Myocardial Infarction With Cardiogenic Shock: Findings From the NCDR. J Am Coll Cardiol, 67(7), 739–747. https://doi.org/10.1016/j.jacc.2015.11.048
Shah, Rashmee U., James A. de Lemos, Tracy Y. Wang, Anita Y. Chen, Laine Thomas, Nadia R. Sutton, James C. Fang, Benjamin M. Scirica, Timothy D. Henry, and Christopher B. Granger. “Post-Hospital Outcomes of Patients With Acute Myocardial Infarction With Cardiogenic Shock: Findings From the NCDR.J Am Coll Cardiol 67, no. 7 (February 23, 2016): 739–47. https://doi.org/10.1016/j.jacc.2015.11.048.
Shah RU, de Lemos JA, Wang TY, Chen AY, Thomas L, Sutton NR, et al. Post-Hospital Outcomes of Patients With Acute Myocardial Infarction With Cardiogenic Shock: Findings From the NCDR. J Am Coll Cardiol. 2016 Feb 23;67(7):739–47.
Shah, Rashmee U., et al. “Post-Hospital Outcomes of Patients With Acute Myocardial Infarction With Cardiogenic Shock: Findings From the NCDR.J Am Coll Cardiol, vol. 67, no. 7, Feb. 2016, pp. 739–47. Pubmed, doi:10.1016/j.jacc.2015.11.048.
Shah RU, de Lemos JA, Wang TY, Chen AY, Thomas L, Sutton NR, Fang JC, Scirica BM, Henry TD, Granger CB. Post-Hospital Outcomes of Patients With Acute Myocardial Infarction With Cardiogenic Shock: Findings From the NCDR. J Am Coll Cardiol. 2016 Feb 23;67(7):739–747.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

February 23, 2016

Volume

67

Issue

7

Start / End Page

739 / 747

Location

United States

Related Subject Headings

  • United States
  • Time Factors
  • Survival Rate
  • Shock, Cardiogenic
  • Risk Assessment
  • Retrospective Studies
  • Registries
  • Prognosis
  • Patient Discharge
  • Myocardial Infarction