Abstract 12600: Racial and Ethnic Disparities in the Management of Acute Myocardial Infarction Complicated by Cardiogenic Shock

Abstract

Background: We sought to evaluate the impact of race/ethnicity on the in-hospital outcomes of acute myocardial infarction-cardiogenic shock (AMI-CS) in contemporary practice. Methods: This is a retrospective cohort study of AMI-CS admissions from the National inpatient Sample (2012-2017). Race was classified as White, Black and, Others (Hispanic, Asian/Pacific Islander, Native Americans). The primary outcome was in-hospital mortality, and secondary outcomes included use of invasive cardiac procedures, length of hospital stay and discharge disposition. Multivariate logistic regression and univariate analysis were used to analyze trends and outcomes. Results: We identified 203,905 (5.8%) AMI-CS admissions, of which 70.4% were White, 8.1% were Black and 15.7% of Other race. Black admissions were more often female, with lower socio-economic status, had higher comorbidities, and higher rates of non-ST-segment-elevation AMI-CS, cardiac arrest, and multi-organ failure. Black and Other races had lower rates of coronary angiography (69.3% vs 73.6% vs 75.3%), percutaneous coronary intervention (48.6% vs 54.8% vs 52.7%), coronary artery bypass grafting (15.1% vs 16.6% vs 19.7%) and mechanical circulatory devices (42.8% vs 43.7% vs 48.3%) compared to White races (all p <0.001). Unadjusted in-hospital mortality was comparable for White (33.3%) and Black (33.8%) and lower for Other race (32.1%). After multivariable regression, the mortality for Black (odds ratio [OR] 0.85 [95% confidence interval {CI} 0.82-0.88]; p <0.001) and Other race (OR 0.97 [95% CI 0.94-1.00]; p= 0.02) was lower than White race. Admissions of Black race had longer hospital stay, and lower rates of discharges to home. Conclusion: Contrary to previous studies, this contemporary study of racial disparities in AMI-CS noted Black and Other races had lower in-hospital mortality despite lower rates of cardiac procedures compared to White admissions.