Background: Acute myocardial infarction (AMI) occurs as a result of irreversible damage to cardiac myocytes secondary to lack of blood supply. Cardiogenic shock complicating AMI has significant associated morbidity and mortality, and data on postdischarge outcomes are limited.

Methods and Results: We derived the study cohort of patients with AMI and cardiogenic shock from the 2013 to 2014 Healthcare Cost and Utilization Project National Readmission Database. Incidence, predictors, and causes of 30-day readmissions were analyzed. From 43 212 index admissions for AMI with cardiogenic shock, 26 016 (60.2%) survived to discharge and 5277 (20.2% of survivors) patients were readmitted within 30 days. More than 50% of these readmissions occurred within first 10 days. Cardiac causes accounted for 42% of 30-day readmissions (heart failure 20.6%; acute coronary syndrome 11.6%). Among noncardiac causes, respiratory (11.4%), infectious (9.4%), medical or surgical care complications (6.3%), gastrointestinal/hepatobiliary (6.5%), and renal causes (4.8%) were most common. Length of stay ≥8 days (odds ratio [OR], 2.04; 95% confidence interval [CI], 1.70–2.44; P<0.01), acute deep venous thrombosis (OR, 1.26; 95% CI, 1.08–1.48; P<0.01), liver disease (OR, 1.25; 95% CI, 1.03–1.50; P=0.02), systemic thromboembolism (OR, 1.21; 95% CI, 1.02–1.44; P=0.02), peripheral vascular disease (OR, 1.16; 95% CI, 1.07–1.27; P<0.01), diabetes mellitus (OR, 1.16; 95% CI, 1.08–1.24; P<0.01), long-term ventricular assist device implantation (OR, 1.77; 95% CI, 1.23–2.55; P<0.01), intraaortic balloon pump use (OR, 1.10; 95% CI, 1.02–1.18; P<0.01), performance of coronary artery bypass grafting (OR, 0.85; 95% CI, 0.77–0.93; P<0.01), private insurance (OR, 0.72; 95% CI, 0.64–0.80; P<0.01), and discharge to home (OR, 0.85; 95% CI, 0.73–0.98; P=0.03) were among the independent predictors of 30-day readmission.

Conclusions: In-hospital mortality and 30-day readmission in cardiogenic shock complicating AMI are significantly elevated. Patients are readmitted mainly for noncardiac causes. Identification of high-risk factors may guide interventions to improve outcomes within this population.

背景：急性心肌梗塞（AMI）的发生是由于血液供应不足对心肌细胞造成的不可逆损害。心源性休克使AMI复杂化具有显着的相关发病率和死亡率，并且出院后结局的数据有限。

方法和结果：我们从2013年至2014年医疗费用与利用项目国家再入院数据库中得出了AMI和心源性休克患者的研究队列。分析了30天再次入院的发生率，预测因素和原因。在因心源性休克发生的AMI的43 212项指标入院后，有26 016名（60.2％）存活至出院，并在30天内重新入院了5277名（幸存者的20.2％）患者。这些再入院的50％以上是在前10天内发生的。心脏原因占30天再入院的42％（心力衰竭20.6％；急性冠状动脉综合征11.6％）。在非心脏原因中，呼吸系统疾病（11.4％），传染性疾病（9.4％），内科或外科手术并发症（6.3％），胃肠道/肝胆疾病（6.5％）和肾脏原因（4.8％）最常见。住院时间≥8天（优势比[OR]为2.04； 95％置信区间[CI]为1.70–2。P <0.01），急性深静脉血栓形成（OR，1.26； 95％CI，1.08–1.48；P <0.01），肝病（OR，1.25； 95％CI，1.03-1.50；P = 0.02），系统性血栓栓塞（或，1.21; 95％CI，1.02-1.44; P = 0.02），周围血管疾病（OR，1.16; 95％CI，1.07-1.27; P <0.01），糖尿病（OR，1.16; 95％CI，1.08） –1.24；P <0.01），长期心室辅助装置植入（OR，1.77； 95％CI，1.23-2.55；P <0.01），主动脉内球囊泵的使用（OR，1.10； 95％CI，1.02-1.18；P <0.01），冠状动脉搭桥术的性能（OR，0.85; 95％CI，0.77–0.93; P <0.01），私人保险（OR，0.72; 95％CI，0.64-0.80; P<0.01）和出院（OR，0.85； 95％CI，0.73-0.98；P = 0.03）是30天再入院的独立预测因素。

结论：心源性休克并发急性心肌梗死的院内死亡率和30天再入院显着增加。患者重新入院主要是因为非心脏原因。确定高危因素可能会指导干预措施以改善该人群的预后。