Abstract 11311: Geographic Variation and Temporal Trends in Management and Outcomes of Cardiac Arrest Complicating Acute Myocardial Infarction in the United States

Abstract

Introduction: Regional variation in the uptake of newer techniques, procedures, and management strategies have been previously reported with acute cardiac care. Limited contemporary information exists on regional differences in the care of acute myocardial infarction (AMI) patients with cardiac arrest (CA). Methods: Using the National Inpatient Sample (2000-2017), we identified adults with AMI and concomitant CA admitted to the United States census regions of Northeast, Midwest, South, and West. Clinical outcomes of interest including in-hospital mortality, use of coronary angiography, percutaneous coronary intervention (PCI), mechanical circulatory support (MCS), hospitalization costs, and length of stay were compared across these four regions. Results: Of 9,680,257 admissions for AMI, 494,083 (5.1%) had concomitant CA. The prevalence of CA in AMI was highest in the West (6.0%) compared to the Northeast (4.4%), Midwest (5.0%), and South (5.1%), p<0.001. Admissions in the West had higher rates of STEMI presentation, cardiogenic shock, multiorgan failure, mechanical ventilation, and hemodialysis. Northeast AMI-CA admissions had lower use of coronary angiography (52.0% vs. 67.9% vs. 60.9% vs. 61.5%), PCI (38.7% vs. 51.9% vs. 44.8% vs. 46.7%), and MCS (18.4% vs. 21.8% vs. 18.1%, vs. 20.0%) compared to the Midwest, West and South (all p<0.001). Compared with the Northeast, adjusted in-hospital mortality for AMI-CA was higher in the Midwest (odds ratio [OR] 1.06 [95% confidence interval {CI} 1.03-1.08]; p<0.001), South (OR 1.11 [95% CI 1.09-1.13]; p<0.001), and highest in the West (OR 1.16 [95% CI 1.13-1.18]; p<0.001). Temporal trends showed a decline in in-hospital mortality except in the West, which showed a slight increase. Compared to other regions, AMI-CA admissions from the Northeast had longer in-hospital stays and less frequent palliative care consultations (all p<0.001). Admissions in the West had higher rates of palliative care consultations, DNR status, and highest hospitalization costs. Conclusions: We identified significant regional disparities in the management and outcomes of AMI-CA. Efforts to improve and provide uniform care for AMI-CA across regions may be essential.