Hospital-Level Variations in Outcomes and Readmissions Among Patients With STEMI and Cardiogenic Shock Receiving Mechanical Circulatory Support: Insights From a National Cohort.

Abstract

BACKGROUND: The utilization of mechanical circulatory support (MCS) in patients presenting with ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS) has increased substantially in recent years. However, it remains unclear whether the spectrum of MCS devices available and the type of hospital in which patients are treated influence clinical outcomes. AIM: To assess the outcomes of patients with STEMI and CS based on availability of MCS devices. METHODS: We utilized the National Readmission Database 2021 to identify STEMI patients with CS. Hospitals were categorized based on MCS device availability into four groups: intra-aortic balloon pump (IABP) centers, Impella centers, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) centers, and transplant centers. Patients were stratified by the level of MCS received, and comparisons were made across hospital types. Our primary aim was to evaluate in-hospital outcomes and 30-day readmission stratified by the type of MCS utilized. RESULTS: A total of 19, 260 patients with STEMI and CS were identified during the study period. Among patients who received IABP only, those admitted in centers with only IABP had the shortest time to MCS initiation compared to other centers. Similarly, among those who received Impella, time to MCS was shortest in centers with Impella only compared to those with VA-ECMO and transplant centers. Among patients who received IABP only, there was no significant difference in mortality based on the location of hospitalization. Patients who received Impella at transplant centers had lower mortality (aOR 0.65, 95% CI 0.43-0.99; p = 0.045) and lower 30-day readmission rates compared with those treated at centers offering only Impella support. CONCLUSION: In patients with STEMI complicated by CS, outcomes vary not only by the type of MCS utilized but also by the MCS capabilities of the treating hospital. These findings suggest that institutional expertise and resource availability may play a significant role in influencing both in-hospital and short-term outcomes, even among patients receiving the same level of circulatory support.