BACKGROUND There are few studies evaluating regional disparities in the care of acute myocardial infarction-cardiogenic shock (AMI-CS). METHODS AND RESULTS Using the National Inpatient Sample from 2000 to 2016, we identified adults with a primary diagnosis of AMI and concomitant CS admitted to the United States census regions of Northeast, Midwest, South, and West. Interhospital transfers were excluded. End points of interest included in-hospital mortality, use of coronary angiography, percutaneous coronary intervention, mechanical circulatory support, hospitalization costs, length of stay, and discharge disposition. Multivariable regression was used to adjust for potential confounding. Of the 402 825 AMI-CS admissions, 16.8%, 22.5%, 39.3%, and 21.4% were admitted to the Northeast, Midwest, South, and West, respectively. Higher rates of ST-elevation AMI-CS were noted in the Midwest and West. Admissions to the Northeast were on average characterized by a higher frequency of whites, Medicare beneficiaries, and lower rates of cardiac arrest. Admissions to the Northeast were less likely to receive coronary angiography, percutaneous coronary intervention, and mechanical circulatory support, despite the highest rates of extracorporeal membrane oxygenation use. Compared with the Northeast, in-hospital mortality was lower in the Midwest (adjusted odds ratio [aOR], 0.96 [95% CI, 0.93-0.98]; P<0.001) and West (aOR, 0.96 [95% CI, 0.94-0.98]; P=0.001) but higher in the South (aOR, 1.04 [95% CI, 1.01-1.06]; P=0.002). The Midwest (aOR, 1.68 [95% CI, 1.62-1.74]; P<0.001), South (aOR, 1.86 [95% CI, 1.80-1.92]; P<0.001), and West (aOR, 1.93 [95% CI, 1.86-2.00]; P<0.001) had higher discharges to home. CONCLUSIONS There remain significant regional disparities in the management and outcomes of AMI-CS.

中文翻译：

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在美国，心源性休克对急性心肌梗塞的处理和结果存在区域差异。

背景很少有研究评估急性心肌梗死-心源性休克（AMI-CS）的区域差异。方法和结果使用2000年至2016年的美国国家住院患者样本，我们确定了主要诊断为AMI并伴随CS进入美国人口普查地区东北，中西部，南部和西部的成年人。医院间转移不包括在内。目的终点包括院内死亡率，冠状动脉造影的使用，经皮冠状动脉介入治疗，机械循环支持，住院费用，住院时间和出院安排。多变量回归用于调整潜在的混淆。在402825例AMI-CS录取中，分别有16.8％，22.5％，39.3％和21.4％录入了东北，中西部，南部和西部。在中西部和西部，ST抬高的AMI-CS发生率更高。平均而言，入东北大学的特点是白人，医疗保险受益人的频率较高，心脏骤停的发生率较低。尽管使用体外膜充氧的比例最高，但入东北的患者不太可能接受冠状动脉造影，经皮冠状动脉介入和机械循环支持。与东北地区相比，中西部地区（调整后的优势比[aOR]，0.96 [95％CI，0.93-0.98]； P <0.001）和西部地区（aOR，0.96 [95％CI，0.94-] 0.98]； P = 0.001），但在南部地区更高（aOR，1.04 [95％CI，1.01-1.06]； P = 0.002）。中西部（aOR，1.68 [95％CI，1.62-1.74]; P <0.001），南部（aOR，1.86 [95％CI，1.80-1.92]; P <0.001）和西部（aOR，1.93 [95％ CI，1.86-2.00]； P ＜0。001）的出院率更高。结论AMI-CS的管理和结果方面仍存在重大地区差异。