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Racial Disparities in the Utilization and Outcomes of Temporary Mechanical Circulatory Support for Acute Myocardial Infarction-Cardiogenic Shock

Vojjini, Rahul ; Patlolla, Sri Harsha ; Cheungpasitporn, Wisit ; Kumar, Arnav ; Sundaragiri, Pranathi R ; Doshi, Rajkumar P ; Jaffe, Allan S ; Barsness, Gregory W ; Holmes, David R ; Rab, S Tanveer ; Vallabhajosyula, Saraschandra

Journal of clinical medicine, 2021-04, Vol.10 (7), p.1459 [Periódico revisado por pares]

Switzerland: MDPI AG

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  • Título:
    Racial Disparities in the Utilization and Outcomes of Temporary Mechanical Circulatory Support for Acute Myocardial Infarction-Cardiogenic Shock
  • Autor: Vojjini, Rahul ; Patlolla, Sri Harsha ; Cheungpasitporn, Wisit ; Kumar, Arnav ; Sundaragiri, Pranathi R ; Doshi, Rajkumar P ; Jaffe, Allan S ; Barsness, Gregory W ; Holmes, David R ; Rab, S Tanveer ; Vallabhajosyula, Saraschandra
  • Assuntos: acute myocardial infarction ; cardiogenic shock ; Classification ; Clinical medicine ; Codes ; Comorbidity ; Demographics ; Ethnicity ; Extracorporeal membrane oxygenation ; healthcare disparities ; Heart attacks ; Inequality ; Length of stay ; mechanical circulatory support ; minorities ; Mortality ; Palliative care ; Patients ; Population ; Race ; Racial differences ; Regression analysis ; Trends
  • É parte de: Journal of clinical medicine, 2021-04, Vol.10 (7), p.1459
  • Notas: ObjectType-Article-1
    SourceType-Scholarly Journals-1
    ObjectType-Feature-2
    content type line 23
    Vojjini and Patlolla contributed equally to this manuscript as co-first authors.
  • Descrição: Racial disparities in utilization and outcomes of mechanical circulatory support (MCS) in patients with acute myocardial infarction-cardiogenic shock (AMI-CS) are infrequently studied. This study sought to evaluate racial disparities in the outcomes of MCS in AMI-CS. The National Inpatient Sample (2012-2017) was used to identify adult AMI-CS admissions receiving MCS support. MCS devices were classified as intra-aortic balloon pump (IABP), percutaneous left ventricular assist device (pLVAD) or extracorporeal membrane oxygenation (ECMO). Self-reported race was classified as white, black and others. Outcomes included in-hospital mortality, hospital length of stay and discharge disposition. During this period, 90,071 admissions were included with white, black and other races constituting 73.6%, 8.3% and 18.1%, respectively. Compared to white and other races, black race admissions were on average younger, female, with greater comorbidities, and non-cardiac organ failure (all < 0.001). Compared to the white race (31.3%), in-hospital mortality was comparable in black (31.4%; adjusted odds ratio (aOR) 0.98 (95% confidence interval (CI) 0.93-1.05); = 0.60) and other (30.2%; aOR 0.96 (95% CI 0.92-1.01); = 0.10). Higher in-hospital mortality was noted in non-white races with concomitant cardiac arrest, and those receiving ECMO support. Black admissions had longer lengths of hospital stay (12.1 ± 14.2, 10.3 ± 11.2, 10.9 ± 1.2 days) and transferred less often (12.6%, 14.2%, 13.9%) compared to white and other races (both < 0.001). In conclusion, this study of AMI-CS admissions receiving MCS devices did not identify racial disparities in in-hospital mortality. Black admissions had longer hospital stay and were transferred less often. Further evaluation with granular data including angiographic and hemodynamic parameters is essential to rule out racial differences.
  • Editor: Switzerland: MDPI AG
  • Idioma: Inglês
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