Abstract P367: Temporal Trends in Cardiogenic Shock and Disparities in Use of PCI Among Patients With Cardiogenic Shock by Race/Ethnicity and Gender, Florida 2001-2007

Abstract

Background: In current ACC/AHA guidelines, early revascularization for cardiogenic shock (CS) complicating acute myocardial infarction (AMI) is a class 1 recommendation in patients aged < 75 years. However, whether the current focus on prompt revascularization during AMI has modified the prevalence of CS is unknown. Therefore, we examined state-wide temporal trends in the prevalence of CS and the use of percutaneous coronary intervention (PCI) by patient age, gender, and race/ethnicity. Methods: Using comprehensive inpatient surveillance for Florida hospitals, we examined all AMI patients (ICD-9-CM 410) discharged between 2001-2007. Data on age, gender, race/ethnicity, AMI type (ST-elevation (STEMI), non-ST-elevation (NSTEMI), and site unspecified), cardiogenic shock (ICD-9-CM 785.50, 785.51) and use of PCI were abstracted for each patient. Temporal trends in the prevalence of CS complicating AMI were examined. Logistic regression analysis was used to examine sociodemographic predictors of the use of PCI among patients with CS. Results: There were 316,285 hospitalizations for AMI in Florida from 2001-2007. Overall 4.1% were complicated by CS. Shock was present in 2.1% of NSTEMI patients, 7.5% of STEMI patients, and 6.0% of unspecified AMI patients. Over time, the prevalence of CS increased from 2001 to 2007 for all AMI patients (3.8% to 4.3%), with the greatest increase among STEMI patients (6.6% to 8.3%). The use of PCI for all AMI patients with CS increased from 28.8% in 2001 to 44.1% in 2007. STEMI patients < 75 years with CS were most likely to receive PCI (49.9% in 2001 increasing to 65.1% in 2007). Logistic regression adjusted for patient age, AMI type, and year revealed that the likelihood of receiving PCI among CS patients was significantly lower for black women (OR 0.68, 95%CI 0.54-0.87, p=0.002) and Hispanic women (OR 0.76, 95% CI 0.64-0.91, p=0.003) compared with white men. Younger CS patients were more likely to receive PCI. Conclusions: The prevalence of cardiogenic shock complicating AMI did not decline in Florida from 2001-2007. However use of PCI among shock patients increased, with the highest use among STEMI patients. Black and Hispanic women with CS were significantly less likely to receive PCI than other race-gender groups.