Type 1 myocardial infarction (MI) is associated with increased in-hospital mortality, and types 1 and 2 MI are associated with increased health care resource use among patients hospitalized with septic shock, according to a study in the American Journal of Cardiology.
Researchers evaluated risk factors and related clinical outcomes in patients with hospitalization for septic shock complicated by type 1 and type 2 MI.
Patient information was obtained from the Nationwide Readmission Database (NRD) from January 1, 2018, to December 31, 2018. International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes were used to identify all primary or secondary hospitalizations with septic shock.
The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay, hospital costs, discharge to a facility, and 30-day all-cause readmissions.
A total of 354,528 hospitalizations for septic shock were included, of which 3.2% of patients had septic shock with type 1 MI (mean age, 72 years; 46.7% women), 3.9% had septic shock with type 2 MI (mean age, 71 years; 47.9% women), and 92.8% had no MI (mean age, 66.2 years; 49% women).
Type 1 MI in patients hospitalized for septic shock is associated with significantly higher in-hospital mortality compared with patients hospitalized for septic shock without MI (36.87% vs 24.07%; adjusted odds ratio [aOR] 1.67; 95% CI, 1.57-1.77). No significant difference in mortality was observed in septic shock hospitalizations in patients with type 2 MI vs those without MI.
Patients with type 1 MI have an increased rate of discharge to a facility (54.01% vs 45.28%; aOR, 1.09; 95% CI, 1.01-1.17) and hospital costs (mean [standard error] $38,453 [$954.62] vs $36,351 [$548.57]; aOR $4571; 95% CI, $3020 to $6122), compared with patients without MI.
Hospitalizations with type 2 MI are associated with higher hospital costs, although the rate of discharge to a facility is similar to that for hospitalizations without MI. Hospitalizations with type 1 MI are associated with higher hospital costs but have a similar rate of discharge to a facility compared with those associated with type 2 MI.
No significant difference was found in the overall rate of 30-day all-cause readmission. Sepsis is the leading cause of readmission for all 3 groups of septic shock hospitalizations (type 1 MI, 27.7%; type 2 MI, 29.0%; no MI, 29.0%), followed by heart failure, renal failure, and respiratory failure.
Among several study limitations, it is possible that the MI diagnoses may be cases of myocardial injury, and the NRD may have miscoded or missing data. Also, additional hospitalizations with MI may have been excluded, and the true prevalence of type 1 and type 2 MI may have been underestimated. Furthermore, the retrospective observational study did not include information on important variables such as echocardiographic results, certain biomarkers, laboratory variables, and treatments at discharge, and the NRD lacks long-term follow-up data.
“There remains an unmet need to improve outcomes for patients hospitalized with septic shock complicated by type 1 and type 2 MI,” the researchers noted.
Kamat IS, Nazir S, Minhas AMK, et al. Outcomes of hospitalizations with septic shock complicated by types 1 and 2 myocardial infarction. Am J Cardiol. Published online May 3, 2022. doi: 10.1016/j.amjcard.2022.03.027