Acute Noncardiac Organ Failure in Acute Myocardial Infarction With Cardiogenic Shock
Acute Noncardiac Organ Failure in Acute Myocardial Infarction With Cardiogenic Shock
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DOI：
10.1016/j.jacc.2019.01.053
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发表时间：
2019-04-16
影响因子：
24
通讯作者：
Barsness, Gregory W.
中科院分区：
文献类型：
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作者：
Vallabhajosyula, Saraschandra;Dunlay, Shannon M.;Barsness, Gregory W.
背景：关于心源性休克并发急性心肌梗死（AMI-CS）的急性非心源性多器官衰竭的数据有限。作者试图评估AMI-CS中单个和多个非心源性器官衰竭的15年全国趋势，资源利用和结局。方法这是一项使用2000年至2014年全国住院患者样本数据库的AMI-CS回顾性队列研究。使用先前验证的呼吸、肾、肝、血液和神经功能衰竭代码识别单器官或多器官（>= 2个器官系统）非心脏器官衰竭。关注的结果是住院死亡率、时间趋势和资源利用。结果在444，253例AMI-CS住院患者中，非心源性单器官或多器官衰竭分别占32.4%和31.9%。多器官功能衰竭更常见于非ST段抬高AMI-CS、非白人和基线合并症较高的入院患者。单器官和多器官衰竭的患病率稳步上升。冠状动脉造影和血运重建术在多器官功能衰竭中较少见。单器官功能衰竭（比值比：1.28; 95%可信区间：1.26 - 1.30）和多器官功能衰竭（比值比：2.23; 95%可信区间：2.19 - 2.27）与较高的住院死亡率、较高的资源利用率和较少的出院回家独立相关。有一个逐步增加的住院死亡率和资源利用与每一个额外的器官failure.CONCLUSIONS有一个稳定的增加，在AMI-CS的多器官功能衰竭的患病率。多器官功能衰竭的存在与较高的住院死亡率和较高的资源利用独立相关。(C)2019年由美国心脏病学会基金会。
BACKGROUND There are limited data on acute noncardiac multiorgan failure in cardiogenic shock complicating acute myocardial infarction (AMI-CS).OBJECTIVES The authors sought to evaluate the 15-year national trends, resource utilization, and outcomes of single and multiple noncardiac organ failures in AMI-CS.METHODS This was a retrospective cohort study of AMI-CS using the National Inpatient Sample database from 2000 to 2014. Previously validated codes for respiratory, renal, hepatic, hematologic, and neurological failure were used to identify single or multiorgan (>= 2 organ systems) noncardiac organ failure. Outcomes of interest were in-hospital mortality, temporal trends, and resource utilization. The effects of every additional organ failure on in-hospital mortality and resource utilization were assessed.RESULTS In 444,253 AMI-CS admissions, noncardiac single or multiorgan failure was noted in 32.4% and 31.9%, respectively. Multiorgan failure was seen more commonly in admissions with non-ST-segment elevation AMI-CS, nonwhite race, and higher baseline comorbidity. There was a steady increase in the prevalence of single and multiorgan failure. Coronary angiography and revascularization were performed less commonly in multiorgan failure. Single-organ failure (odds ratio: 1.28; 95% confidence interval: 1.26 to 1.30) and multiorgan failure (odds ratio: 2.23; 95% confidence interval: 2.19 to 2.27) were independently associated with higher in-hospital mortality, greater resource utilization, and fewer discharges to home. There was a stepwise increase in in-hospital mortality and resource utilization with each additional organ failure.CONCLUSIONS There has been a steady increase in the prevalence of multiorgan failure in AMI-CS. Presence of multiorgan failure was independently associated with higher in-hospital mortality and greater resource utilization. (C) 2019 by the American College of Cardiology Foundation.