• Resuscitation · Jan 2022

    Geographic variation and temporal trends in management and outcomes of cardiac arrest complicating acute myocardial infarction in the United States.

    • Auras R Atreya, Sri Harsha Patlolla, Chandan M Devireddy, Wissam A Jaber, S Tanveer Rab, William J Nicholson, John S Douglas, Spencer B King, and Saraschandra Vallabhajosyula.
    • Institute of Cardiac Sciences and Research, AIG Hospitals, Hyderabad, India.
    • Resuscitation. 2022 Jan 1; 170: 339-348.

    BackgroundLimited studies have evaluated regional disparities in the care of acute myocardial infarction (AMI) patients with cardiac arrest (CA). This study sought to evaluate 18-year national trends, resource utilization, and geographical variation in outcomes in AMI-CA admissions.Methods And ResultsUsing the National Inpatient Sample (2000-2017), we identified adults with AMI and concomitant CA admitted to the United States census regions of Northeast, Midwest, South, and West. Clinical outcomes of interest included in-hospital mortality, use of coronary angiography, percutaneous coronary intervention (PCI), mechanical circulatory support (MCS), hospitalization costs and length of stay. Of 9,680,257 admissions for AMI, 494,083 (5.1%) had concomitant CA. The West (6.0%) had higher prevalence compared to the Northeast (4.4%), Midwest (5.0%), and South (5.1%), p < 0.001. Admissions in the West had higher rates of STEMI, cardiogenic shock, multiorgan failure, mechanical ventilation, and hemodialysis. Northeast admissions had lower use of coronary angiography (52.0% vs. 67.9% vs. 60.9% vs. 61.5%), PCI (38.7% vs. 51.9% vs. 44.8% vs. 46.7%), and MCS (18.4% vs. 21.8% vs. 18.1%, vs. 20.0%) compared to the Midwest, West and South (all p < 0.001). Compared with the Northeast, adjusted in-hospital mortality was higher in the Midwest (odds ratio [OR] 1.06 [95% confidence interval {CI} 1.03-1.08]), South (OR 1.11 [95% CI 1.09-1.13]) and highest in the West (OR 1.16 [95% CI 1.13-1.18]), all p < 0.001. Temporal trends showed a decline in in-hospital mortality except in the West, which showed a slight increase.ConclusionsThere remain significant regional disparities in the management and outcomes of AMI-CA.Copyright © 2021 Elsevier B.V. All rights reserved.

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