Burden of Arrhythmias in Acute Myocardial Infarction Complicated by Cardiogenic Shock

Saraschandra Vallabhajosyula, Sri Harsha Patlolla, Dhiran Verghese, Lina Ya'Qoub, Vinayak Kumar, Anna V. Subramaniam, Wisit Cheungpasitporn, Pranathi R. Sundaragiri, Peter A. Noseworthy, Siva K. Mulpuru, Malcolm R. Bell, Bernard J. Gersh, Abhishek J. Deshmukh

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


There are limited data on arrhythmias in acute myocardial infarction with cardiogenic shock (AMI-CS). Using a 17-year AMI-CS population from the National Inpatient Sample, we identified common arrhythmias – atrial fibrillation (AF), atrial flutter, supraventricular tachycardia, ventricular tachycardia, ventricular fibrillation, and atrioventricular blocks (AVB). Admissions with concomitant cardiac surgery were excluded. Outcomes of interest included temporal trends, predictors, in-hospital mortality, and resource utilization in cohorts with and without arrhythmias. Of the 420,319 admissions with AMI-CS during 2000 to 2016, arrhythmias were noted in 213,718 (51%). AF (45%), ventricular tachycardia (35%) and ventricular fibrillation (30%) were the most common arrhythmias. Compared with those without, the cohort w`ith arrhythmias was more often male, of white race, with ST-segment elevation AMI-CS presentation, and had higher rates of cardiac arrest and acute organ failure (all p <0.001). Temporal trends of prevalence revealed a stable trend of atrial and ventricular arrhythmias and declining trend in AVB. The cohort with arrhythmias had higher unadjusted (42% vs 41%; odds ratio [OR] 1.03 [95% confidence interval 1.02 to 1.05]; p <0.001), but not adjusted (OR 1.01 [95% CI 0.99 to 1.03]; p = 0.22) in-hospital mortality compared with those without. The cohort with arrhythmias had longer hospital stay (9 ± 10 vs 7 ± 9 days; p <0.001) and higher hospitalization costs ($124,000 ± 146,000 vs $91,000 ± 115,000; p <0.001). In the cohort with arrhythmias, older age, female sex, non-white race, higher co-morbidity, presence of acute organ failure, and cardiac arrest, predicted higher in-hospital mortality. In conclusion, cardiac arrhythmias in AMI-CS are a marker of higher illness severity and are associated with greater resource utilization.

Original languageEnglish (US)
Pages (from-to)1774-1781
Number of pages8
JournalAmerican Journal of Cardiology
Issue number12
StatePublished - Jun 15 2020

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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