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Concomitant Sepsis Diagnoses in Acute Myocardial Infarction-Cardiogenic Shock: 15-Year National Temporal Trends, Management, and Outcomes

September 19, 2022

OBJECTIVES:
Mixed cardiogenic-septic shock is common and associated with high mortality. There are limited contemporary data on concomitant sepsis in acute myocardial infarction complicated by cardiogenic shock (AMI-CS).
DESIGN:
Observational study.
SETTING:
Twenty percent stratified sample of all community hospitals (2000–2014) in the United States.
PARTICIPANTS:
Adults (> 18 yr) with AMI-CS with and without concomitant sepsis.
INTERVENTIONS:
None.
MEASUREMENTS AND MAIN RESULTS:
Outcomes of interest included inhospital mortality, development of noncardiac organ failure, complications, utili- zation of guideline-directed procedures, length of stay, and hospitalization costs. Over 15 years, 444,253 AMI-CS admissions were identified, of which 27,057 (6%) included sepsis. The sepsis cohort had more comorbidities and had higher rates of noncardiac multiple organ failure (92% vs 69%) (all p < 0.001). In 2014, compared with 2000, the prevalence of sepsis increased from 0.5% versus 11.5% with an adjusted odds ratio (aOR) 11.71 (95% CI, 9.7–14.0) in ST-segment el- evation myocardial infarction and 24.6 (CI, 16.4–36.7) (all p < 0.001) in non-ST segment elevation myocardial infarction. The sepsis cohort received fewer cardiac interventions (coronary angiography [65% vs 68%], percutaneous coronary in- tervention [43% vs 48%]) and had greater use of mechanical circulatory support (48% vs 45%) and noncardiac support (invasive mechanical ventilation [65% vs 41%] and acute hemodialysis [12% vs 3%]) (p < 0.001). The sepsis cohort had higher inhospital mortality (44.3% vs 38.1%; aOR, 1.21; 95% CI, 1.18–1.25; p < 0.001), longer length of stay (14.0 d [7–24 d] vs 7.0 d [3–12 d]), greater hospitalization costs (×1,000 U.S. dollars) ($176.0 [$85–$331] vs $77.0 [$36– $147]), fewer discharges to home (22% vs 44%) and more discharges to skilled nursing facilities (51% vs 28%) (all p < 0.001). CONCLUSIONS:
In AMI-CS, concomitant sepsis is associated with higher mor- tality and morbidity highlighting the need for early recognition and integrated man- agement of mixed shock.

KEY WORDS:
acute myocardial infarction; cardiogenic shock; circulatory shock; critical care cardiology; sepsis