Abstract 9833: Incidence and Predictors of Acute Limb Ischemia in Patients with Acute Myocardial Infarction Complicated by Cardiogenic Shock - Insight from National Readmission Database

Abstract

Introduction: Cardiogenic shock (CS) is an ominous complication of acute myocardial infarction (AMI) that has a mortality as high as 50%. Use of percutaneous mechanical circulatory support devices (MCSD) has increased in attempts to improve outcomes, however its use can be complicated by acute limb ischemia (ALI). In contemporary clinical practice the incidence and predictors of this complication not known. Methods: Patients with index hospitalizations for AMI complicated by CS in the U.S. Nationwide Readmissions Database were identified from January 2016 to December 2018 using International Classification of Diseases (ICD) 10 codes (“I21-”, “I214”, “R57-”). We evaluated the incidence of ALI and its impact on mortality, length of stay, and cost of hospitalization. We used logistic regression analysis to determine independent predictors of ALI in this population. Results: Amongst a total of 61,950 patients had AMI complicated by CS and 922 (1.49%) developed ALI. The rates of ALI increased from 1.29% in 2016 to 1.66% in 2018. Utilization of microaxial MCSD increase from 2.245% in 2016 to 14.03% in 2018. The major predictors of ALI included peripheral arterial disease (PAD) (OR, 7.86, 95% CI 6.34 to 9.76), veno-arterial extracorporeal membrane oxygenation (ECMO-VA) cannulation (OR, 2.96, 95% CI of 1.53 to 5.73), and microaxial MCSD implantation (OR, 2.91, 95% CI of 2.48 to 3.41). (Figure 1). ALI patients had higher mortality (41.37% vs 34.07%, p=<0.001), longer length of stay (17.33 ± 17.92 vs 9.73 ± 11.43) and higher charges (507,955 ± 610,337 vs 249,904 ± 305,385). Conclusions: This nationwide observational study shows that ALI is not an infrequent complication in patients with AMI complicated by CS. This complication is associated with higher mortality, and longer length of stay. Presence of PAD and use of MCSD is associated with significantly higher risk of ALI.