Abstract 13000: Trends in Incidence, Invasive Management and Outcomes of Cardiogenic Shock Complicating Non ST-Segment Elevation Myocardial Infarction

Abstract

Background: Cardiogenic shock complicating Acute Myocardial Infarction (AMI) is usually described in the setting of a ST-segment elevation MI (STEMI). However, the trend in incidence, invasive management and outcomes of cardiogenic shock complicating NSTEMI, are not well defined. Methods: We analyzed patients in the Nationwide Inpatient Sample (NIS) between 2002-2011 with primary discharge diagnosis of Acute Myocardial Infarction (AMI) and secondary diagnosis of cardiogenic shock. Primary outcome was trend in cardiogenic shock complicating NSTEMI. Secondary outcome was trends in in-hospital mortality. Results: We identified 6,667,087 patients with AMI among which 4,032,193(60.5% of AMI) had NSTEMI and 2,634,894(39.5%) had STEMI. Cardiogenic shock complicated , 92,654(2.3%) patients with NSTEMI and 204,389(7.8%) patients with STEMI. Among patients with cardiogenic shock, there was a steady increase in proportion of patients with NSTEMI (vs. STEMI) (23.6% to 38.0% from 2002 to 2011, p<0.001). While an increasing percentage of NSTEMI shock patients underwent invasive management (55.1% to 67.3% from 2002 to 2011, p<0.001) this was significant lower when compared with STEMI shock (68.0% to 84.0% from 2002 to 2011, p<0.001) patients. Mortality in NSTEMI and STEMI shock patients were similar and continued to account for high in-hospital mortality (36.6% vs. 38.9%, P<0.001). Conclusions: Among patients with cardiogenic shock complicating AMI, there are an increasing proportion of patients with shock complicating NSTEMI. While the percentage of patients with NSTEMI shock undergoing invasive management has increased it continues to be lower as compared to STEMI shock despite similarly high in-hospital mortality.