Bansal Kannu, Gupta Mohak, Garg Mohil, Patel Neel, Truesdell Alexander G, Babar Basir Mir, Rab Syed Tanveer, Ahmad Tariq, Kapur Navin K, Desai Nihar, Vallabhajosyula Saraschandra
Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA.
Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
JACC Heart Fail. 2024 Dec;12(12):2087-2097. doi: 10.1016/j.jchf.2024.07.014. Epub 2024 Sep 4.
There are limited data on volume-outcome relationships in acute myocardial infarction (AMI) with cardiogenic shock (CS).
In this study, the authors sought to evaluate the association between hospital percutaneous coronary intervention (PCI) volume and readmission after AMI-CS.
Adult AMI-CS patients were identified from the Nationwide Readmissions Database for 2016-2019 and were categorized into hospital quartiles (Q1 lowest volume to Q4 highest) based on annual inpatient PCI volume. Outcomes of interest included 30-day all-cause, cardiac, noncardiac, and heart-failure (HF) readmissions.
There were 49,558 AMI-CS admissions at 3,954 PCI-performing hospitals. Median annual PCI volume was 174 (Q1-Q3: 70-316). Patients treated at Q1 hospitals were on average older, female, and with higher comorbidity burden. Patients at Q4 hospitals had higher rates of noncardiac organ dysfunction, complications, and use of cardiac support therapies. Overall, 30-day readmission rate was 18.5% (n = 9,179), of which cardiac, noncardiac, and HF readmissions constituted 56.2%, 43.8%, and 25.8%, respectively. From Q1 to Q4, there were no differences in 30-day all-cause (17.6%, 18.4%, 18.2%, 18.7%; P = 0.55), cardiac (10.9%, 11.0%, 10.6%, 10.2%; P = 0.29), and HF (5.0%, 4.8%, 4.8%, 4.8%; P = 0.99) readmissions. Noncardiac readmissions were noted more commonly in higher quartiles (6.7%, 7.4%, 7.7%, 8.5%; P = 0.001) but was not significant after multivariable adjustment. No relationship was noted between hospital PCI volume as a continuous variable and readmissions.
In AMI-CS, there was no association between hospital annual PCI volume and 30-day readmissions despite higher acuity in the higher volume PCI centers suggestive of better care pathways for CS at higher volume centers.
关于急性心肌梗死（AMI）合并心源性休克（CS）时容量-结局关系的数据有限。
在本研究中，作者试图评估医院经皮冠状动脉介入治疗（PCI）量与AMI-CS后再入院之间的关联。
从2016 - 2019年全国再入院数据库中识别成年AMI-CS患者，并根据年度住院PCI量将其分为医院四分位数（Q1最低量至Q4最高量）。感兴趣的结局包括30天全因、心脏、非心脏和心力衰竭（HF）再入院。
在3954家进行PCI的医院中有49558例AMI-CS入院。年度PCI量中位数为174（Q1 - Q3：70 - 316）。在Q1医院接受治疗的患者平均年龄更大，女性居多，合并症负担更高。Q4医院的患者非心脏器官功能障碍、并发症及心脏支持治疗的使用率更高。总体而言，30天再入院率为18.5%（n = 9179），其中心脏、非心脏和HF再入院分别占56.2%、43.8%和25.8%。从Q1到Q4，30天全因（17.6%、18.4%、18.2%、18.7%；P = 0.55）、心脏（10.9%、11.0%、10.6%、10.2%；P = 0.29）和HF（5.0%、4.8%、4.8%、4.8%；P = 0.99）再入院率无差异。非心脏再入院在较高四分位数中更常见（6.7%、7.4%、7.7%、8.5%；P = 0.001），但多变量调整后无显著性差异。未发现作为连续变量的医院PCI量与再入院之间存在关系。
在AMI-CS中，尽管高容量PCI中心的病情更严重，提示其对CS有更好的治疗途径，但医院年度PCI量与30天再入院之间无关联。
