Background

There are limited epidemiological data on acute respiratory failure (ARF) in cardiogenic shock complicating acute myocardial infarction (AMI-CS). This study sought to evaluate the prevalence and outcomes of ARF in AMI-CS.

Methods

This was a retrospective study of AMI-CS admissions during 2000–2014 from the National Inpatient Sample. Administrative codes for ARF and mechanical ventilation (MV) were used to define the cohorts of no ARF, ARF without MV and ARF with MV. Admissions with a secondary diagnosis of AMI and with chronic MV were excluded. Outcomes of interest included in-hospital mortality, temporal trends of ARF prevalence and resource utilization.

Measurements and main results

During 2000–2014, 439,436 admissions for AMI-CS met the inclusion criteria. ARF and MV were noted in 57% and 43%, respectively. Admissions with non-ST-elevation AMI-CS, of non-White race and with non-private insurance received MV more frequently. Noninvasive ventilation and invasive MV increased from 0.4% and 39.2% (2000) to 3.6% and 46.4% (2014), respectively (p < 0.001). Coronary angiography and percutaneous coronary intervention were used less frequently in admissions receiving ARF with MV. Compared to admissions with no ARF, ARF without MV (adjusted odds ratio (aOR) 1.56 [95% confidence interval (CI) 1.53–1.59]; p < 0.001) and ARF with MV (aOR 2.50 [95% CI 2.47–2.54]; p < 0.001) were associated with higher in-hospital mortality. Admissions with ARF without MV had greater resource utilization and lesser discharges to home as compared to no ARF.

Conclusions

In this contemporary AMI-CS cohort, the presence of ARF and MV use was noted in 57% and 43%, respectively, and was associated with higher in-hospital mortality.

中文翻译：

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在美国，2000-2014年，心源性休克并发急性心肌梗死的急性呼吸衰竭和机械通气。

背景

关于心源性休克并发急性心肌梗死（AMI-CS）的急性呼吸衰竭（ARF）的流行病学数据有限。本研究旨在评估AMI-CS中ARF的患病率和转归。

方法

这是一项对2000-2014年美国国家住院患者样本中AMI-CS入院的回顾性研究。ARF和机械通气（MV）的管理代码用于定义无ARF，无MV的ARF和有MV的ARF的队列。排除具有AMI继发性诊断和慢性MV的入选者。感兴趣的结果包括院内死亡率，ARF流行的时间趋势和资源利用。

测量和主要结果

在2000–2014年期间，有439,436例AMI-CS入院符合纳入标准。ARF和MV分别占57％和43％。非ST高程AMI-CS，非白人种族和非私人保险的入学者获得MV的频率更高。无创通气和有创MV分别从0.4％和39.2％（2000）增至3.6％和46.4％（2014）（p  <0.001）。接受ARF和MV的入院患者较少使用冠状动脉造影和经皮冠状动脉介入治疗。与没有ARF的入院者相比，没有MV的ARF（调整后的优势比（aOR）1.56 [95％置信区间（CI）1.53–1.59]；p  <0.001）和带有MV的ARF（aOR 2.50 [95％CI 2.47–2.54] ；p <0.001）与更高的院内死亡率相关。与没有ARF相比，没有MV的ARF入场者具有更高的资源利用率和更少的出院数量。

结论

在这个当代的AMI-CS队列中，使用ARF和MV的比例分别为57％和43％，并与更高的院内死亡率相关。