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Incidence, management, and in-hospital mortality of cardiogenic shock complicating ST-elevated myocardial infarction in China: insights from the China Acute Myocardial Infarction Registry
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1Fuwai Hospital- Chinese Academy of Medical Sciences and Peking Union Medical College - Beijing - China
On behalf: the CAMI Registry Study Group
Background and Purpose: Limited data is available on the situation of cardiogenic shock (CS) complicating ST-elevated myocardial infarction (STEMI) in China. This study aims to disclose the incidence, management and in-hospital mortality (IHM) of patients with STEMI complicated by CS (STEMICS) in China and at different levels of hospitals. Methods: We queried the 2013-2016 China Acute Myocardial Infarction (CAMI) registry databases to identify patients with STEMI and/or CS (developing before or during hospitalization). The overall and different hospital-level incidence of STEMICS and IHM were analyzed. Results: Of 28230 STEMI patients, 2273 patients (8.05%) had CS. The incidence of STEMICS in provincial, prefectural and county-level hospitals were 5.23%, 8.46% and 13.76% (p < 0.001), respectively. Primary PCI (PPCI) was performed on 675 patients (29.7%) with STEMICS. The proportion of STEMICS patients undertaking PPCI in provincial, prefectural and county-level hospitals were 46.53%, 31.48% and 8.00% (p < 0.001). The overall IHM rate of patients with STEMICS was 49.8% with no difference among the different hospital levels. However, the IHM rate of prehospital STEMICS in county-level hospitals were significantly higher than that in prefectural and provincial hospitals (42.3% versus 33.3% and 28.3%, respectively; p <0.01), while that of in-hospital STEMICS were similar among the different hospital levels (66.5%, 66.9% and 62.2%; provincial, prefectural and county-level hospitals, respectively). After adjustment, the difference of IHM in prehospital STEMICS between county-level hospitals and the other two levels no longer existed. However, once PPCI was excluded from the multivariable adjustment model, the IHM of prehospital STEMICS remained higher in county-level hospitals. Conclusion: The overall incidence and IHM rate of STEMICS in China are still high. Especially, higher IHM rate of prehospital STEMICS is observed in county-level hospitals, which may be attributed to the lower implementation rate of PPCI.
Provincial hospitals/ County-level hospitals
Prefectural hospitals/ County-level hospitals
Unadjusted OR (95% CI)
0.54 (0.36, 0.80); P=0.0019
0.68(0.49, 0.94); P=0.0193
Adjusted OR* (95% CI)
0.63 (0.34, 1.17); P=0.1455
0.64 (0.38, 1.08); P=0.0962
Adjusted OR† (95% CI)
0.49 (0.27, 0.90); P=0.0214
0.54 (0.32, 0.91); P=0.0198
Table. Differences in IHM of prehospital STEMICS between county-level hospitals and other two levels of hospitals before or after adjustment.
IHM: in-hospital mortality. OR: odd ratio; CI: confidence interval.
*: adjusted for baseline characteristics, in-hospital medications and primary PCI;
†: adjusted for baseline characteristics and in-hospital medications.
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