Between the years 2000 and 2014, there was a rise in the prevalence of multiple organ failure in the United States in patients with cardiogenic shock complicating acute myocardial infarction (AMI-CS). During the same period, in-hospital mortality and an increase in resource utilization was associated with the presence of multiple organ failure in patients with AMI-CS, according to findings from a retrospective cohort study of the National Inpatient Sample (NIS) database published in JACC.
Researchers retrospectively collected patient data from the NIS, focusing their efforts on identifying and collecting admissions data for patients with AMI-CS (n=444,253) during 2000 to 2014.
Single or multiple organ (involving ≥2 organ systems) noncardiac organ failure were identified using codes for hepatic, hematologic, respiratory, renal, and neurologic failure. Primary study outcomes included in-hospital mortality, temporal trends, as well as resource utilization. Also, researchers assessed the impact of every additional organ failure event on both in-hospital mortality and resource utilization.
A similar percentage of single and multiple organ failures was observed in the study cohort (32.4% vs 31.9%, respectively). In an adjusted analysis, the presence of single organ failure and multiple organ failure was associated with lower use of percutaneous coronary intervention (odds ratio [OR], 0.72; 95% CI, 0.71-0.74 and OR, 0.69; 95% CI, 0.68-0.71, respectively) and coronary angiography (OR, 0.79; 95% CI, 0.78-0.81 and OR, 0.68; 95% CI, 0.67-0.70, respectively).
Higher in-hospital mortality, greater resource utilization, and fewer discharges to home were associated with single-organ failure (OR, 1.28; 95% CI, 1.26-1.30) and multiple organ failure (OR, 2.23; 95% CI, 2.19-2.27).
For each additional organ system failure there was a stepwise increase in the odds of in-hospital mortality compared with no organ failure. Stepwise increases in hospital length of stay, hospitalization costs, and discharge to care facilities were also observed for each additional organ failure.
A limitation of the analysis includes the lack of data on the presence of organ failure at hospital admission, the timing of organ failure, and the resolution of laboratory markers related to organ injury and dysfunction.
“Dedicated clinical research into [the] pathophysiology and disease-specific factors in AMI-CS is warranted to prevent and treat multiorgan failure in an attempt to improve clinical care and outcomes,” the investigators concluded.
Vallabhajosyula S, Dunlay SM, Prasad A, et al. Acute noncardiac organ failure in acute myocardial infarction with cardiogenic shock. JACC. 2019;73(14):1781–1791.