Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC.
Department of Medicine, Appalachian Regional Healthcare, Whitesburg, KY.
Am Heart J. 2022 Feb;244:54-65. doi: 10.1016/j.ahj.2021.11.002. Epub 2021 Nov 11.
To evaluate the epidemiology and outcomes of non-ST-segment-elevation myocardial infarction-cardiogenic shock (NSTEMI-CS) in the United States.
Adult (>18 years) NSTEMI-CS admissions were identified using the National Inpatient Sample (2000-2017) and classified by tertiles of admission year (2000-2005, 2006-2011 and 2012-2017). Outcomes of interest included temporal trends of prevalence and in-hospital mortality, use of cardiac procedures, in-hospital mortality, hospitalization costs, and length of stay.
In over 7.3 million NSTEMI admissions, CS was noted in 189,155 (2.6%). NSTEMI-CS increased from 1.5% in 2000 to 3.6% in 2017 (adjusted odds ratio 2.03 [95% confidence interval 1.97-2.09]; P < .001). Rates of non-cardiac organ failure and cardiac arrest increased during the study period. Between 2000 and 2017, coronary angiography (43.9%-63.9%), early coronary angiography (13.6%-25.6%), percutaneous coronary intervention (14.8%-31.6%), and coronary artery bypass grafting use (19.0%-25.8%) increased (P < .001). Over the study period, the use of intra-aortic balloon pump remained stable (28.6%-28.8%), and both percutaneous left ventricular assist devices (0%-9.1%) and extra-corporeal membrane oxygenation (0.1%-1.6%) increased (all P < .001). In hospital mortality decreased from 50.2% in 2000 to 32.3% in 2017 (adjusted odds ratio 0.27 [95% confidence interval 0.25-0.29]; P < .001). During the 18-year period, hospital lengths of stay decreased, and hospitalization costs increased.
In the United States, prevalence of CS in NSTEMI has increased 2-fold between 2000 and 2017, while in-hospital mortality has decreased during the study period. Use of coronary angiography and percutaneous coronary intervention increased during the study period.
评估美国非 ST 段抬高型心肌梗死合并心原性休克（NSTEMI-CS）的流行病学和结局。
使用国家住院患者样本（2000-2017 年）确定成年（>18 岁）NSTEMI-CS 入院患者，并按入院年份的三分位数（2000-2005 年、2006-2011 年和 2012-2017 年）进行分类。研究结果包括患病率和院内死亡率、心脏手术使用情况、院内死亡率、住院费用和住院时间的时间趋势。
在超过 730 万例 NSTEMI 入院患者中，CS 出现在 189155 例（2.6%）中。NSTEMI-CS 的比例从 2000 年的 1.5%增加到 2017 年的 3.6%（调整后的优势比为 2.03[95%置信区间为 1.97-2.09]；P<.001）。在研究期间，非心脏器官衰竭和心脏骤停的发生率增加。在 2000 年至 2017 年期间，冠状动脉造影（43.9%-63.9%）、早期冠状动脉造影（13.6%-25.6%）、经皮冠状动脉介入治疗（14.8%-31.6%）和冠状动脉旁路移植术使用率（19.0%-25.8%）增加（P<.001）。在研究期间，主动脉内球囊泵的使用保持稳定（28.6%-28.8%），而经皮左心室辅助装置（0%-9.1%）和体外膜氧合（0.1%-1.6%）的使用均增加（均 P<.001）。院内死亡率从 2000 年的 50.2%降至 2017 年的 32.3%（调整后的优势比为 0.27[95%置信区间为 0.25-0.29]；P<.001）。在 18 年期间，住院时间缩短，住院费用增加。
在美国，2000 年至 2017 年间，NSTEMI 合并 CS 的比例增加了两倍，而在此期间，院内死亡率有所下降。在研究期间，冠状动脉造影和经皮冠状动脉介入治疗的使用率增加。
