Diabetes and Its Impact on Cardiogenic Shock Outcomes in Acute Myocardial Infarction with Polyvascular Disease: A Comparative Analysis
Abstract
:1. Introduction
2. Methods
2.1. Data Source
2.2. Study Design and Population
2.3. Outcomes
2.4. Statistical Analysis
3. Results
3.1. In-Hospital Procedures and Outcomes
Crude Rates
3.2. Adjusted Analysis
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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No DM | With DM | p-Value | |
---|---|---|---|
NIS discharge weight | 18,000 | 21,140 | <0.001 |
Mean age, years | 72.1 | 69.5 | <0.001 |
Female, % | 34.2 | 36.7 | <0.001 |
Ethnicity, % | <0.001 | ||
White | 78.0 | 62.3 | |
Black | 9.2 | 13.3 | |
Hispanic | 5.9 | 13.8 | |
Asian | 2.8 | 5.6 | |
Native | 0.6 | 0.9 | |
Other | 3.5 | 4.1 | |
Hospital region, % | <0.001 | ||
Northeast | 15.4 | 13.8 | |
Midwest or North Central | 23.8 | 22.5 | |
South | 40.3 | 38.8 | |
West | 20.5 | 24.9 | |
Hospital bed size, % | 0.374 | ||
Small | 13.6 | 13.3 | |
Medium | 27.0 | 27.6 | |
Large | 59.4 | 59.1 | |
Hospital location/teaching status, % | <0.001 | ||
Rural | 4.2 | 3.5 | |
Urban non-teaching | 17.4 | 19.1 | |
Teaching | 787.4 | 77.4 | |
Median ZIP income | <0.001 | ||
1st Quartile | 29.0 | 31.3 | |
2nd Quartile | 26.9 | 27.0 | |
3rd Quartile | 24.3 | 23.5 | |
4th Quartile | 19.8 | 18.2 | |
Primary Expected Payer, % | <0.001 | ||
Medicare | 71.3 | 72.6 | |
Medicaid | 7.0 | 7.9 | |
Private Insurance | 16.5 | 14.7 | |
Self-pay | 2.8 | 2.7 | |
No charge | 0.1 | 0.1 | |
Other | 2.3 | 2.1 | |
Record Characteristics, % | |||
STEMI | 50.0 | 38.2 | <0.001 |
Cardiac arrest | 8.7 | 9.0 | 0.238 |
Ventricular fibrillation | 15.1 | 10.5 | <0.001 |
Ventricular tachycardia | 20.3 | 19.0 | 0.001 |
Length of stay, days, mean | 9.6 | 10.4 | <0.001 |
Total charge, USD, mean | $239,538 | $252,202 | <0.001 |
Comorbidities, % | |||
Heart failure | 67.8 | 75.3 | <0.001 |
Valvular heart disease | 25.4 | 23.1 | <0.001 |
Hypertension | 82.3 | 92.8 | <0.001 |
Atrial fibrillation | 37.5 | 34.7 | <0.001 |
Smoking | 49.0 | 37.5 | <0.001 |
Dementia | 6.2 | 5.7 | 0.040 |
Chronic kidney disease | 57.8 | 78.2 | <0.001 |
Obesity | 10.8 | 22.1 | <0.001 |
Anemia | 49.2 | 55.6 | <0.001 |
Thrombocytopenia | 16.9 | 16.4 | 0.164 |
Coagulopathy | 6.9 | 5.9 | <0.001 |
Chronic liver disease | 0.9 | 1.2 | <0.001 |
Hematologic malignancy | 1.8 | 0.9 | <0.001 |
Solid malignancy | 2.9 | 1.8 | <0.001 |
Metastatic malignancy | 1.3 | 0.5 | <0.001 |
No DM | With DM | p-Value | |
---|---|---|---|
NIS discharge weight | 18,000 | 21,140 | <0.001 |
In-hospital procedures | |||
Coronary angiography, % | 80.4 | 79.9 | 0.194 |
PCI, % | 49.3 | 46.3 | <0.001 |
CABG, % | 18.2 | 20.2 | <0.001 |
Thrombolysis, % | 0.3 | 0.3 | 0.651 |
Mechanical ventilation, % | 46.8 | 46.4 | 0.456 |
Circulatory support (inc. IABP, LV assist device and ECMO), % | 43.1 | 42.6 | 0.382 |
In-hospital complications | |||
MACCE, % | 43.1 | 40.8 | <0.001 |
Mortality, % | 36.4 | 35.8 | 0.215 |
Acute CVA, % | 4.3 | 3.7 | 0.004 |
Cardiac complications | |||
Coronary artery dissection, % | 1.7 | 0.7 | <0.001 |
Pericardial effusion (including tamponade), % | 3.1 | 2.5 | <0.001 |
Tamponade, % | 1.1 | 0.8 | 0.004 |
Dressler’s syndrome, % | 0.2 | 0.2 | 0.373 |
Post-MI angina, % | 0.5 | 0.5 | 0.548 |
Intracardiac thrombus, % | 0.6 | 0.3 | <0.001 |
Mechanical complications, % | 1.0 | 0.2 | <0.001 |
Vascular complications, % | 0.7 | 0.3 | <0.001 |
Major GI bleeding, % | 11.7 | 7.7 | <0.001 |
GI bleeding, % | 7.7 | 5.9 | <0.001 |
Procedural related bleeding, % | 3.2 | 1.5 | <0.001 |
Intracerebral hemorrhage, % | 0.6 | 0.5 | 0.127 |
Retroperitoneal bleeding, % | 0.7 | 0.2 | <0.001 |
Post-procedural shock, % | 0.4 | 0.3 | 0.024 |
Outcome | aOR (95% CI) | p Value |
---|---|---|
In-hospital procedures | ||
Coronary angiography | 0.96 (0.91–1.01) | 0.136 |
PCI | 1.01 (0.97–1.06) | 0.567 |
CABG | 0.96 (0.91–1.02) | 0.211 |
Thrombolysis | 0.97 (0.67–1.40) | 0.878 |
Mechanical ventilation | 1.01 (0.96–1.05) | 0.790 |
Circulatory support (inc. IABP, LV assist device and ECMO) | 0.97 (0.93–1.02) | 0.232 |
In-hospital complications | ||
MACCE | 1.05 (1.01–1.10) | 0.020 |
Mortality | 1.17 (1.11–1.23) | <0.001 |
Acute CVA | 0.90 (0.81–1.01) | 0.065 |
Major bleeding | 0.62 (0.58–0.67) | <0.001 |
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Gatuz, M.V.; Abu-Fanne, R.; Abramov, D.; Mamas, M.A.; Roguin, A.; Kobo, O. Diabetes and Its Impact on Cardiogenic Shock Outcomes in Acute Myocardial Infarction with Polyvascular Disease: A Comparative Analysis. Biomedicines 2024, 12, 1900. https://doi.org/10.3390/biomedicines12081900
Gatuz MV, Abu-Fanne R, Abramov D, Mamas MA, Roguin A, Kobo O. Diabetes and Its Impact on Cardiogenic Shock Outcomes in Acute Myocardial Infarction with Polyvascular Disease: A Comparative Analysis. Biomedicines. 2024; 12(8):1900. https://doi.org/10.3390/biomedicines12081900
Chicago/Turabian StyleGatuz, Marlon V., Rami Abu-Fanne, Dmitry Abramov, Mamas A. Mamas, Ariel Roguin, and Ofer Kobo. 2024. "Diabetes and Its Impact on Cardiogenic Shock Outcomes in Acute Myocardial Infarction with Polyvascular Disease: A Comparative Analysis" Biomedicines 12, no. 8: 1900. https://doi.org/10.3390/biomedicines12081900