Sex disparities in acute kidney injury complicating acute myocardial infarction with cardiogenic shock

Abstract

Aims To evaluate sex‐specific disparities in acute kidney injury (AKI) complicating acute myocardial infarction‐related cardiogenic shock (AMI‐CS) in the United States. Methods and results This was a retrospective cohort study from 2000 to 2014 from the National Inpatient Sample (20% sample of all hospitals in the United States). Patients >18 years admitted with a primary diagnosis of AMI and concomitant CS that developed AKI were included. The endpoints of interest were the prevalence, trends, and outcomes of men and women with AKI in AMI‐CS. Multivariable hierarchical logistic regression was used to control for confounding, and a two‐sided P < 0.05 was considered statistically significant. During this 15 year period, 440 257 admissions with AMI‐CS met the inclusion criteria, with AKI noted in 155 610 (35.3%). Women constituted 36.3% of the cohort and were older, of non‐White race, and with higher co‐morbidity compared with men. Women with AKI less often received coronary angiography (59% vs. 66%), percutaneous coronary intervention (39% vs. 43%), mechanical circulatory support (39% vs. 48%), mechanical ventilation (49% vs. 54%), and haemodialysis (9% vs. 10%) compared with men (all P < 0.001). Adjusted in‐hospital mortality was higher in women—odds ratio 1.16 (95% confidence interval 1.14–1.19); P < 0.001—compared with men. Women had shorter lengths of stay (12 ± 14 vs. 13 ± 14 days), lower hospital costs ($150 071 ± 180 796 vs. $181 260 ± 209 674), and were less often discharged to home (19% vs. 31%) (all P < 0.001). Conclusions Women with AKI in AMI‐CS received fewer cardiac and non‐cardiac interventions, had higher in‐hospital mortality, and were less often discharged to home compared with men.

Complications from percutaneous-left ventricular assist devices versus intra-aortic balloon pump in acute myocardial infarction-cardiogenic shock

“…This is similar to prior studies of ECMO and Impella which found higher risk of bleeding requiring blood transfusion and development of acute kidney injury (AKI) [8]. This is potentially related to increased risk of hemolysis, vascular complications and hypovolemia causing pre-renal hypoperfusion [8]. In our study there were no unique predictors of complications in pLVAD, however, risk of complication in IABP was associated with advanced age, non-ST-segment elevation Multivariable adjusted odds ratios (95% confidence intervals) � for occurrence of complications (A) and in-hospital mortality in admissions with complications in AMI-CS supported by pLVAD compared to IABP; all p<0.001 where 95% confidence interval does not include unity.…”

“…Hepatic failure and ECMO support were strong predictors of worse outcomes. This is similar to prior studies of ECMO and Impella which found higher risk of bleeding requiring blood transfusion and development of acute kidney injury (AKI) [8]. This is potentially related to increased risk of hemolysis, vascular complications and hypovolemia causing pre-renal hypoperfusion [8].…”

“…However, large-scale randomized trials like IABP-SHOCK II (Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock) have demonstrated no difference in AMI-CS outcomes with or without the IABP [5]. Newer devices including TandemHeart, Impella and extracorporeal membrane oxygenation (ECMO) have been introduced into clinical practice in the last 10-15 years, with Impella being the most commonly used today [6][7][8][9][10][11][12][13][14][15][16][17].…”

Complications in Patients with Acute Myocardial Infarction Supported with Extracorporeal Membrane Oxygenation

“…During the period between 1 January 2000 through 31 December 2016, a retrospective cohort of admissions from the HCUP-NIS with a primary diagnosis of AMI (International Classification of Disease-9 Clinical Modification [ICD-9CM] 410.x; International Classification of Disease-10 Clinical Modification [ICD-10CM] I21.x-22.x) receiving ECMO support (ICD-9CM 39.65; ICD-10CM 5A15223) were identified consistent with prior literature [7]. Deyo's modification of Charlson Comorbidity Index was used to identify co-morbid diseases and prior methodology was used to identify cardiac and non-cardiac procedures [2,3,7,8,11,[13][14][15][16][17][18][19][20][21][22][23]. We identified relevant complications and categorized them as (a) vascular complications-arterial injury, acquired arterio-venous fistula, and vascular complications requiring surgery; (b) lower limb amputation; (c) hematologic-post-operative hemorrhage, hemolytic anemia, thrombocytopenia, and blood transfusion; and (d) neurologic-ischemic or hemorrhagic stroke ( Supplementary Table S1).…”

Weekend Effect in the Management and Outcomes of Acute Myocardial Infarction in the United States, 2000-2016

“…16 Demographic characteristics, hospital characteristics, acute organ failure, mechanical circulatory support, cardiac procedures, and noncardiac organ support use were identified for all admissions using previously used methods from our group. [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] Similar to previous literature, we defined early coronary angiography (CA) as that performed on the day of hospital admission (day 0). 21,30,31 We identified the timing of CA and PCI relative to the day of admission.…”