期刊
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
卷 79, 期 13, 页码 1223-1235出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2022.01.037
关键词
cardiogenic shock; coronary artery bypass grafting; mechanical circulatory support; myocardial infarction; percutaneous coronary intervention; peripheral artery disease
资金
- National Institutes of Health (NIH) [T32HL007208]
- Medtronic
- Boston Scientific
- Abbott Vascular
- Abiomed
- CSI
- CathWorks
- Siemens
- Philips
- ReCor Medical
- TriReme Medical
- SurModics
- Shockwave Medical
- NIH
- Intact Vascular
- AstraZeneca
- National Heart, Lung, and Blood Institute [R01HL136708]
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology
- NIH/NHLBI [K23HL150290]
- Food & Drug Administration
- Harvard Medical School's Shore Faculty Development Award
- Bard
- Cook Medical
- Laminate Medical
This study found that PAD was associated with worse limb outcomes and survival among patients with AMI and CS. Compared to those without PAD, patients with PAD had higher risks of in-hospital mortality, amputation, and out-of-hospital mortality.
BACKGROUND Mortality rates for patients presenting with acute myocardial infarction (AMI) and cardiogenic shock (CS) remain high despite advances in revascularization strategies and mechanical circulatory support (MCS) devices. OBJECTIVES This study sought to elucidate the association between comorbid lower extremity peripheral artery disease (PAD) and outcomes in CS and AMI. METHODS PAD status was defined in Medicare beneficiaries hospitalized with CS and AMI from October 1, 2015 to June 30, 2018. Primary outcomes ascertained through December 31, 2018 included in-and out-of-hospital mortality. Secondary outcomes included bleeding, amputation, stroke, and lower extremity revascularization. Multivariable regression models with adjustment for confounders were used to estimate risk. Subgroup analyses included patients treated with MCS and those who underwent coronary revascularization. RESULTS Among 71,690 patients, 5.9% (N = 4,259) had PAD. Mean age was 77.8 +/- 7.9 years, 58.7% were male, and 84.3% were White. Cumulative in-hospital mortality was 47.2%, with greater risk among those with PAD (56.3% vs 46.6% without PAD; adjusted OR: 1.50; 95% CI: 1.40-1.59). PAD patients also had greater risk of in-hospital amputation (1.6% vs 0.2%; adjusted OR: 7.0; 95% CI: 5.26-9.37) and out-of-hospital mortality (67.9% vs 40.7%; adjusted HR: 1.78; 95% CI: 1.67-1.90). MCS was less frequently utilized in PAD patients (21.5% vs 38.6% without PAD; P < 0.001) and was associated with higher mortality, need for lower extremity revascularization, and amputation risk. Findings were consistent in patients who underwent coronary revascularization. CONCLUSIONS Among patients presenting with AMI and CS, PAD was associated with worse limb outcomes and survival. In addition to lower MCS utilization rates, those with PAD who received MCS had increased mortality, lower extremity revascularization, and amputation rates. (C) 2022 by the American College of Cardiology Foundation.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据