Abstract
Racial disparities in utilization and outcomes of mechanical circulatory support (MCS) in patients with acute myocardial infarction-cardiogenic shock (AMI-CS) are infrequently studied. This study sought to evaluate racial disparities in the outcomes of MCS in AMI-CS. The National Inpatient Sample (2012–2017) was used to identify adult AMI-CS admissions receiving MCS support. MCS devices were classified as intra-aortic balloon pump (IABP), percutaneous left ventricular assist device (pLVAD) or extracorporeal membrane oxygenation (ECMO). Self-reported race was classified as white, black and others. Outcomes included in-hospital mortality, hospital length of stay and discharge disposition. During this period, 90,071 admissions were included with white, black and other races constituting 73.6%, 8.3% and 18.1%, respectively. Compared to white and other races, black race admissions were on average younger, female, with greater comorbidities, and non-cardiac organ failure (all p < 0.001). Compared to the white race (31.3%), in-hospital mortality was comparable in black (31.4%; adjusted odds ratio (aOR) 0.98 (95% confidence interval (CI) 0.93–1.05); p = 0.60) and other (30.2%; aOR 0.96 (95% CI 0.92–1.01); p = 0.10). Higher in-hospital mortality was noted in non-white races with concomitant cardiac arrest, and those receiving ECMO support. Black admissions had longer lengths of hospital stay (12.1 ± 14.2, 10.3 ± 11.2, 10.9 ± 1.2 days) and transferred less often (12.6%, 14.2%, 13.9%) compared to white and other races (both p < 0.001). In conclusion, this study of AMI-CS admissions receiving MCS devices did not identify racial disparities in in-hospital mortality. Black admissions had longer hospital stay and were transferred less often. Further evaluation with granular data including angiographic and hemodynamic parameters is essential to rule out racial differences.
Highlights
Around 5–10% of all acute myocardial infarction (AMI) admissions are complicated by cardiogenic shock (CS)
Studies have demonstrated racial, regional, sex based and age related disparities in treatment and outcomes of acute myocardial infarction-cardiogenic shock (AMI-CS) patients [2,9,10,11] Reports focusing on racial differences in AMI-CS population have shown that non-white patients are associated with lower use of guideline directed therapies and worse outcomes [9,12] these reports are either more than a decade old or are non-specific and include patients with CS secondary to multiple causes. [9,12] we evaluated racial disparities in the utilization and outcomes of temporary mechanical circulatory support (MCS) specific for AMI-CS using large-scale contemporary data
We identified use of MCS devices: extracorporeal membrane oxygenation (ECMO), intraaortic balloon pump (IABP) and percutaneous left ventricular assist device (Impella or TandemHeart) using respective ICD-CM and ICD-PCS codes
Summary
Around 5–10% of all acute myocardial infarction (AMI) admissions are complicated by cardiogenic shock (CS). Due to the need for significant resource allocation and technical support, it is conceivable that health care inequalities due to patient demographics such as age, sex and race may arise in this population, similar to that in other conditions in acute cardiovascular care [6,7,8]. Studies have demonstrated racial, regional, sex based and age related disparities in treatment and outcomes of AMI-CS patients [2,9,10,11] Reports focusing on racial differences in AMI-CS population have shown that non-white patients are associated with lower use of guideline directed therapies and worse outcomes [9,12] these reports are either more than a decade old or are non-specific and include patients with CS secondary to multiple causes. Clinical characteristics and management strategies of AMI-CS stratified by race
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
