The impact of atrial fibrillation on in-hospital outcomes in patients with acute myocardial infarction complicated by cardiogenic shock undergoing coronary revascularization with percutaneous ventricular assist device support

Sonu Gupta, Rupak Desai, Bishoy Hann, Abhishek Deshmukh, Gautam Kumar, Rajesh Sachdeva, Adam E. Berman

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Atrial fibrillation (AF) is common in acute myocardial infarction complicated by cardiogenic shock (AMI-CS) requiring percutaneous ventricular assist device (pVAD-Impella®) support during percutaneous coronary interventions (PCI). We evaluated the effects of a coexistent diagnosis of AF on clinical outcomes in patients with AMI-CS undergoing PCI with pVAD support. Methods: The National Inpatient Sample (2008-2014) was queried to identify patients with AMICS requiring PCI with pVAD support and had a concomitant diagnosis of AF. Propensity-matched cohorts (AF+ vs AF-) were compared for in-hospital outcomes. Results: A total of 840 patients with AMICS requiring PCI with pVAD support (420 AF+ vs 420 AF-) were identified in the matched cohort. Patients with AF were older (mean 69.7±12.0 vs 67.9±11.3 yrs, p=0.030). All-cause in-hospital mortality rates between the two groups were similar (40.5% vs 36.7%, p=0.245); however, higher postprocedural respiratory complications (9.5% vs 4.8%, p=0.007) were seen in AF+ group. In-hospital cardiac arrests were more frequent in the AF- group (32.0% vs 19.2%, p<0.001). We examined the length of stay (LOS), transfer to other facilities, and hospital charges as metrics of health care resource consumption and found that the AF+ cohort experienced fewer routine discharges (13.1% vs 30.2%), more frequent transfers to other facilities including skilled nursing facilities or intermediate care facilities (27.3% vs 17.8%; p<0.001), more frequently required the use of home health care (14.3% vs 7.1%; p<0.001). The mean LOS (11.9±10.1 vs 9.11±6.8, p<0.001) and hospital charges ($308,478 vs $277,982, p=0.008) were higher in the AF+ group. Conclusion: In patients suffering AMICS requiring PCI and pVAD support, a coexistent diagnosis of AF was not associated with an increase in all-cause in-hospital mortality as compared to patients without AF. However, healthcare resource consumption as assessed by various metrics was consistently greater in the AF+ group.

Original languageEnglish (US)
JournalJournal of Atrial Fibrillation
Volume12
Issue number5
DOIs
StatePublished - 2020

Keywords

  • Acute Myocardial Infarction
  • All-Cause Mortality
  • Arrhythmia
  • Atrial Fibrillation
  • Cardiogenic Shock
  • Impella
  • Outcomes
  • Percutaneous Ventricular Assist Device (Pvad)

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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