Epidemiological trends in the timing of in-hospital death in acute myocardial infarction-cardiogenic shock in the United States

Saraschandra Vallabhajosyula, Shannon M. Dunlay, Malcolm R. Bell, P. Elliott Miller, Wisit Cheungpasitporn, Pranathi R. Sundaragiri, Kianoush Kashani, Bernard J. Gersh, Allan S. Jaffe, David R. Holmes, Gregory W. Barsness

Research output: Contribution to journalArticlepeer-review


Background: There are limited data on the epidemiology and timing of in-hospital death (IHD) in patients with acute myocardial infarction-cardiogenic shock (AMI-CS). Methods: Adult admissions with AMI-CS with IHDs were identified using the National Inpatient Sample (2000–2016) and were classified as early (≤2 days), mid-term (3–7 days), and late (>7 days). Inter-hospital transfers and those with do-not-resuscitate statuses were excluded. The outcomes of interest included the epidemiology, temporal trends and predictors for IHD timing. Results: IHD was noted in 113,349 AMI-CS admissions (median time to IHD 3 (interquartile range 1–7) days), with early, mid-term and late IHD in 44%, 32% and 24%, respectively. Compared to the mid-term and late groups, the early IHD group had higher rates of ST-segment-elevation AMI-CS (74%, 63%, 60%) and cardiac arrest (37%, 33%, 29%), but lower rates of acute organ failure (68%, 79%, 89%), use of coronary angiography (45%, 56%, 67%), percutaneous coronary intervention (33%, 36%, 42%), and mechanical circulatory support (31%, 39%, 50%) (all p < 0.001). There was a temporal increase in the early (adjusted odds ratio (aOR) for 2016 vs. 2000 2.50 (95% confidence interval (CI) 2.22–2.78)) and a decrease in mid-term (aOR 0.75 (95% CI 0.71–0.79)) and late (aOR 0.34 (95% CI 0.31–0.37)) IHD. ST-segment-elevation AMI-CS and cardiac arrest were associated with the increased risk of early IHD, whereas advanced comorbidity and acute organ failure were associated with late IHD. Conclusions: Early IHD after AMI-CS has increased between 2000 and 2016. The populations with early vs. late IHD were systematically different.

Original languageEnglish (US)
Article number2094
Pages (from-to)1-8
Number of pages8
JournalJournal of Clinical Medicine
Issue number7
StatePublished - Jul 2020


  • Acute myocardial infarction
  • Cardiac intensive care unit
  • Cardiogenic shock
  • Critical care cardiology
  • In-hospital death
  • Outcomes research

ASJC Scopus subject areas

  • General Medicine


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