Cardiogenic Shock Complicating Non-ST-Segment Elevation Myocardial Infarction: An 18-Year Study.

OBJECTIVE To evaluate the epidemiology and outcomes of non-ST-segment-elevation myocardial infarction-cardiogenic shock (NSTEMI-CS) in the United States. METHODS 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. RESULTS 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 [aOR] 2.03 [95% confidence interval {CI} 1.97-2.09]; p<0.001). Rates of non-cardiac organ failure and cardiac arrest increased during the study period. Between 2000 and 2017, coronary angiography (43.9% to 63.9%), early coronary angiography (13.6% to 25.6%), percutaneous coronary intervention (14.8% to 31.6%), and coronary artery bypass grafting use (19.0% to 25.8%) increased (p<0.001). Over the study period, the use of intra-aortic balloon pump remained stable (28.6% to 28.8%), and both percutaneous left ventricular assist devices (0% to 9.1%) and extra-corporeal membrane oxygenation (0.1% to 1.6%) increased (all p<0.001). In hospital mortality decreased from 50.2% in 2000 to 32.3% in 2017 (aOR 0.27 [95% CI 0.25-0.29]; p<0.001). During the 18-year period, hospital lengths of stay decreased, and hospitalization costs increased. CONCLUSIONS 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 PCI increased during the study period.