Cardiac Shock in Patients Hospitalized for Acute Myocardial Infarction
Authors: Evbayekha Endurance O. , Nriagu Bede N. , Ohikhuai Evidence E. , Ibeson Emeka C. , Ogundiran Faithful T. , Onyechi Nkemputaife P. , Ogbonna Uchechukwu O. , Akinade Omotola , Umeh Nneka J. , Ilechie Ekene , Adedoyin Adewale M. , Diorgu Kelechim N. , Iluno Chinedum I. , Iroro Joy , Omogunwa Adebola E. , Okobi Okelue E. 
Published: October 2022

Introduction: There is a paucity of data on in-hospital outcomes and mortality in individuals with myocardial infarction (MI) complicated by cardiogenic shock (CS). However, this complication greatly affects prognosis amongst other factors and is a fairly common concern. We aim to add to the existing body of knowledge in this regard. Methods and Results: Patients with MI admitted from January 1, 2005, to December 31, 2014, were identified from the US National Inpatient Sample. We reported the crude and adjusted trends of in-hospital mortality among the population and selected subgroups. Among 73,573,571 hospitalizations spanning from January 1, 2005, to December 31, 2014, 1,208,029 (1.65%) were attributed to MI. Of these, the number of hospitalized individuals admitted primarily for myocardial infarction with a secondary diagnosis of CS (MICS) was 60,661 (5.02%), 62% (37,885) of which were men. The prevalence by racial ethnicity was 76.13% (39,282) whites, 7.51% (3873) blacks, and (4239) 8.22% Asians. The mean age of all affected with MICS was 68.6 years (SD=13.2). The mortality outcome of the 60661 affected was 21283, i.e., 35.10% mortality. There has been a steady increase in hospitalizations in individuals with myocardial infarction and a secondary diagnosis of cardiogenic shock from 68 per 100 000 hospitalizations in 2005 to 103 per 100 000 hospitalizations in 2014 (p =0.001), it showed 9% vs. 12.2% increase (p =0.001). Of the people that died from MICS, 76.30% (13,754) were white, and Asians and blacks were 8.38% (1,510) and 7.54% (1,359). However, there was no statistical significance in racial differences as p =0.33. Mortality across the various hospital regions showed no statistical significance, p =0.88. However, the mortality among patients with MICS in the in-hospital setting decreased (from 40.80% (2226/5456) in 2005 to 33.70% (2456/7288) in 2014; p =0.001). The mean length of stay (LOS) trend decreased from 9.14 days (SD=10.6) in 2010 to 8.88 days (SD=10.6) in 2013 (p =0.001). There was, however, an upsurge in total hospital charges (CRG) from $147,727 (SD=153,847) in 2010 to $172,357 (SD=201,168) in 2013 (p =0.001). Weekend or weekday admission showed no significant difference in mortality outcome, 73.01% (44,263) vs. 26.99% (16,363) (p =0.18). The adjusted rate for mortality by month revealed that there was a significant increase in in-hospital mortality in December and January (p =0.005). There was a significant difference among patients with congestive cardiac failure (CCF), p =0.001, but type 2 diabetes (T2DM) did not significantly affect the mortality outcomes of these patients. Conclusions: Hospitalizations attributed to MICS rose significantly from January 2005 to December 2014. Our study delineated a decline in MICS in-hospital mortality during this period. Furthermore, a general increase in mortality during December and January was observed in the studied population.