• Cardiogenic shock
• Gender-specific disparities
• Percutaneous left ventricular assist devices

• Acute myocardial infarction
• Cardiac arrest
• Cardiogenic shock
• Disparities
• Race
• Sex

• Female
• Humans
• Male
• Ethnicity
• Health Status Disparities
• Healthcare Disparities/ethnology
• Myocardial Infarction/ethnology
• Myocardial Infarction/therapy
• Racial Groups
• Risk Factors
• Sex Factors
• United States/epidemiology

• AKI
• Cardiogenic shock
• Mortality
• ST-elevation myocardial infarction

• Humans
• Female
• Male
• Quality of Life
• Disease Progression
• Renal Insufficiency, Chronic/epidemiology
• Renal Insufficiency, Chronic/therapy
• Renal Insufficiency, Chronic/etiology
• Kidney Transplantation/adverse effects
• Cardiovascular Diseases
• Glomerular Filtration Rate

• KLI 754 Austrian Science Fund FWF

Renal ischemia–reperfusion injury (IRI) is less extensive in females than males in both animals and humans; however, this protection diminishes after menopause, suggesting that estrogen plays a pivotal role in IRI, but the underlying mechanism remains largely unknown. Our study found that 45 min of warm ischemia was sufficient to induce significant pathological changes without causing death in model animals. Compared with male rats, female rats exhibited less extensive apoptosis, kidney injury, and fibrosis; these effects were worsened in ovariectomized (OVX) rats and ameliorated upon estradiol (E₂) supplementation. Furthermore, the levels of TGF-βRI, but not TGF-βRII or TGF-β1, were significantly increased in OVX rats, accompanied by phosphorylated SMAD2/3 activation. Interestingly, the alteration trend of the nuclear ERα level was opposite that of TGF-βRI. Furthermore, dual luciferase reporter and chromatin immunoprecipitation assays showed that ERα could bind to the promoter region of TGF-βRI and negatively regulate its mRNA expression. Moreover, an in vitro study using NRK-52E cells showed that ERα knockdown blocked E₂-mediated protection, while TGF-βRI knockdown protected cells against hypoxic insult. The findings of this study suggest that renal IRI is closely related to the TGF-βRI-SMAD pathway in females and that E₂ exert its protective effect via the ERα-mediated transcriptional inhibition of TGF-βRI expression.

• ERα
• SMAD
• TGF-βR1
• estradiol
• ischemia-reperfusion injury

• acute myocardial infarction
• cardiogenic shock
• health care
• insurance
• outcomes research

• Aged
• Aged, 80 and over
• Cardiovascular Surgical Procedures
• Cohort Studies
• Coronary Angiography/statistics & numerical data
• Databases, Factual
• Female
• Hospital Costs
• Hospital Mortality
• Hospitalization/statistics & numerical data
• Humans
• Incidence
• Intra-Aortic Balloon Pumping/statistics & numerical data
• Male
• Middle Aged
• Practice Patterns, Physicians'/statistics & numerical data
• Procedures and Techniques Utilization
• ST Elevation Myocardial Infarction/complications
• ST Elevation Myocardial Infarction/mortality
• ST Elevation Myocardial Infarction/therapy
• Shock, Cardiogenic/diagnosis
• Shock, Cardiogenic/epidemiology
• Shock, Cardiogenic/therapy
• Time Factors
• United States

Acute myocardial infarction (AMI) with left ventricular (LV) dysfunction patients, the most common cause of cardiogenic shock (CS), have acutely deteriorating hemodynamic status. The frequent use of vasopressor and inotropic pharmacologic interventions along with mechanical circulatory support (MCS) in these patients necessitates invasive hemodynamic monitoring. After the pivotal Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness trial failed to show a significant improvement in clinical outcomes in shock patients managed with a pulmonary artery catheter (PAC), the use of PAC has become less popular in clinical practice. In this review, we summarize currently available literature to summarize the indications, clinical relevance, and recommendations for use of PAC in the setting of AMI-CS.

• Pulmonary artery catheter
• Swan-ganz catheter
• Acute myocardial infarction
• Cardiogenic shock
• Hemodynamic monitoring
• Interventional cardiology
• Critical care cardiology

• Acute myocardial infarction
• Cardiogenic shock
• Healthcare disparities
• Minorities
• Race

• Acute myocardial infarction
• Cardiac critical care
• Cardiogenic shock
• Outcomes research
• Respiratory infections

Background and Objectives: Contemporary data on the prevalence, management and outcomes of acute myocardial infarction (AMI) in relation to body mass index (BMI) are limited. Materials and Methods: Using the National Inpatient Sample from 2008 through 2017, we identified adult AMI hospitalizations and categorized them into underweight (BMI < 19.9 kg/m²), normal BMI and overweight/obese (BMI > 24.9 kg/m²) groups. We evaluated in-hospital mortality, utilization of cardiac procedures and resource utilization among these groups. Results: Among 6,089,979 admissions for AMI, 38,070 (0.6%) were underweight, 5,094,721 (83.7%) had normal BMI, and 957,188 (15.7%) were overweight or obese. Over the study period, an increase in the prevalence of AMI was observed in underweight and overweight/obese admissions. Underweight AMI admissions were, on average, older, with higher comorbidity, whereas overweight/obese admissions were younger and had lower comorbidity. In comparison to the normal BMI and overweight/obese categories, significantly lower use of coronary angiography (62.3% vs. 74.6% vs. 37.9%) and PCI (40.8% vs. 47.7% vs. 19.6%) was observed in underweight admissions (all p < 0.001). The underweight category was associated with significantly higher in-hospital mortality (10.0% vs. 5.5%; OR 1.23 (95% CI 1.18–1.27), p < 0.001), whereas being overweight/obese was associated with significantly lower in-hospital mortality compared to normal BMI admissions (3.1% vs. 5.5%; OR 0.73 (95% CI 0.72–0.74), p < 0.001). Underweight AMI admissions had longer lengths of in-hospital stay with frequent discharges to skilled nursing facilities, while overweight/obese admissions had higher hospitalization costs. Conclusions: In-hospital management and outcomes of AMI vary by BMI. Underweight status was associated with worse outcomes, whereas the obesity paradox was apparent, with better outcomes for overweight/obese admissions.

• acute myocardial infarction
• cardiovascular risk factors
• obesity
• outcomes research
• underweight

• Adult
• Body Mass Index
• Hospitals
• Humans
• Myocardial Infarction/epidemiology
• Myocardial Infarction/therapy
• Overweight/complications
• Overweight/epidemiology
• Percutaneous Coronary Intervention
• Risk Factors
• Thinness/epidemiology

The role of insurance on outcomes in non-ST-segment-elevation myocardial infarction (NSTEMI) patients is limited in the contemporary era.

From the National Inpatient Sample, adult NSTEMI admissions were identified [2000–2017]. Expected primary payer was classified into Medicare, Medicaid, private, uninsured and others. Outcomes included in-hospital mortality, overall and early coronary angiography, percutaneous coronary intervention (PCI), resource utilization and discharge disposition.

Of the 7,290,565 NSTEMI admissions, Medicare, Medicaid, private, uninsured and other insurances were noted in 62.9%, 6.1%, 24.1%, 4.6% and 2.3%, respectively. Compared to others, those with Medicare insurance older (76 vs. 53–60 years), more likely to be female (48% vs. 25–44%), of white race, and with higher comorbidity (all P<0.001). Population from the Medicare cohort had higher in-hospital mortality (5.6%) compared to the others (1.9–3.4%), P<0.001. With Medicare as referent, in-hospital mortality was higher in other {adjusted odds ratio (aOR) 1.15 [95% confidence interval (CI), 1.11–1.19]; P<0.001}, and lower in Medicaid [aOR 0.95 (95% CI, 0.92–0.97); P<0.001], private [aOR 0.77 (95% CI, 0.75–0.78); P<0.001] and uninsured cohorts [aOR 0.97 (95% CI, 0.94–1.00); P=0.06] in a multivariable analysis. Coronary angiography (overall 52% vs. 65–74%; early 15% vs. 22–27%) and PCI (27% vs. 35–44%) were used lesser in the Medicare population. The Medicare population had longer lengths of stay, lowest hospitalization costs and fewer home discharges.

Compared to other types of primary payers, NSTEMI admissions with Medicare insurance had lower use of coronary angiography and PCI, and higher in-hospital mortality.

• Myocardial infarction
• health disparities
• insurance
• outcomes research
• primary payer

• Acute myocardial infarction
• Cardiac arrest
• Cardio-oncology
• Critical care cardiology
• cancer

• acute kidney injury
• acute myocardial infarction
• cardiogenic shock
• critical care cardiology

• acute myocardial infarction
• cardiac arrest
• healthcare disparities
• minorities
• outcomes research
• race

• Aged
• Coronary Angiography
• Disease Management
• Ethnicity
• Female
• Follow-Up Studies
• Healthcare Disparities/ethnology
• Heart Arrest/ethnology
• Heart Arrest/etiology
• Heart Arrest/therapy
• Hospital Mortality/ethnology
• Humans
• Male
• Middle Aged
• Myocardial Infarction/complications
• Myocardial Infarction/diagnosis
• Myocardial Infarction/mortality
• Racial Groups
• Retrospective Studies
• United States/epidemiology

• TL1 TR001864 NCATS NIH HHS
• UL1 TR000135 NCATS NIH HHS
• UL1 TR001863 NCATS NIH HHS
• National Center for Advancing Translational Sciences
• National Institutes of Health

• Acute kidney injury
• Cardiogenic shock
• Heart failure
• Outcome
• Replacement therapy

• Acute Kidney Injury/diagnosis
• Acute Kidney Injury/epidemiology
• Acute Kidney Injury/etiology
• Humans
• Prognosis
• Shock, Cardiogenic/epidemiology
• Shock, Cardiogenic/etiology

• Università degli Studi di Siena

• AMI, acute myocardial infarction
• CA, cardiac arrest
• CS, cardiogenic shock
• ED, emergency department
• HR, hazard ratio
• ICD-10-CM, International Classification of Diseases, Tenth Revision, Clinical Modification
• ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification
• MCS, mechanical circulatory support
• PCI, percutaneous coronary intervention
• SNF, skilled nursing facility

• UL1 TR000135 NCATS NIH HHS

• Cardiogenic shock
• Outcomes research
• Percutaneous coronary intervention
• ST-segment elevation myocardial infarction
• Thrombolytics

• Acute heart failure
• Acute myocardial infarction
• Cardiac arrest
• Cardiogenic shock
• Female
• Sex differences
• Spontaneous coronary artery dissection
• Takotsubo cardiomyopathy

• Estrogen
• acute kidney injury (AKI)
• chronic kidney disease (CKD)
• estrogen receptors (ERs)
• kidney diseases

• Acute Kidney Injury/metabolism
• Acute Kidney Injury/pathology
• Animals
• Disease Progression
• Estrogens/metabolism
• Humans
• Kidney Tubules, Proximal/metabolism
• Kidney Tubules, Proximal/pathology
• Mitochondria/metabolism
• Receptors, Estrogen/metabolism
• Renal Insufficiency, Chronic/metabolism
• Renal Insufficiency, Chronic/pathology
• Signal Transduction

There are limited contemporary data on the influence of primary payer status on the management and outcomes of ST-segment elevation myocardial infarction (STEMI).

To assess the influence of insurance status on STEMI outcomes.

Adult (>18 years) STEMI admissions were identified using the National Inpatient Sample database (2000–2017). Expected primary payer was classified into Medicare, Medicaid, private, uninsured and others. Outcomes of interest included in-hospital mortality, use of coronary angiography and percutaneous coronary intervention (PCI), hospitalization costs, hospital length of stay and discharge disposition.

Of the 4,310,703 STEMI admissions, Medicare, Medicaid, private, uninsured and other insurances were noted in 49.0%, 6.3%, 34.4%, 7.2% and 3.1%, respectively. Compared to the others, the Medicare cohort was older (75 vs. 53–57 years), more often female (46% vs. 20–36%), of white race, and with higher comorbidity (all p<0.001). The Medicare and Medicaid population had higher rates of cardiogenic shock and cardiac arrest. The Medicare cohort had higher in-hospital mortality (14.2%) compared to the other groups (4.1–6.7%), p<0.001. In a multivariable analysis (Medicare referent), in-hospital mortality was higher in uninsured (adjusted odds ratio (aOR) 1.14 [95% confidence interval {CI} 1.11–1.16]), and lower in Medicaid (aOR 0.96 [95% CI 0.94–0.99]; p = 0.002), privately insured (aOR 0.73 [95% CI 0.72–0.75]) and other insurance (aOR 0.91 [95% CI 0.88–0.94]); all p<0.001. Coronary angiography (60% vs. 77–82%) and PCI (45% vs. 63–70%) were used less frequently in the Medicare population compared to others. The Medicare and Medicaid populations had longer lengths of hospital stay, and the Medicare population had the lowest hospitalization costs and fewer discharges to home.

Compared to other types of primary payers, STEMI admissions with Medicare insurance had lower use of coronary angiography and PCI, and higher in-hospital mortality.

• Aged
• Female
• Humans
• Insurance, Health/statistics & numerical data
• Male
• Medicaid/statistics & numerical data
• Middle Aged
• Prognosis
• ST Elevation Myocardial Infarction/diagnosis
• ST Elevation Myocardial Infarction/economics
• United States

• UL1 TR000135 NCATS NIH HHS
• National Center for Advancing Translational Sciences (US)

Background: There are limited data on acute myocardial infarction with cardiogenic shock (AMI-CS) stratified by chronic kidney disease (CKD) stages. Objective: To assess clinical outcomes in AMI-CS stratified by CKD stages. Methods: A retrospective cohort of AMI-CS during 2005–2016 from the National Inpatient Sample was categorized as no CKD, CKD stage-III (CKD-III), CKD stage-IV (CKD-IV) and end-stage renal disease (ESRD). CKD-I/II were excluded. Outcomes included in-hospital mortality, use of coronary angiography, percutaneous coronary intervention (PCI) and mechanical circulatory support (MCS). We also evaluated acute kidney injury (AKI) and acute hemodialysis in non-ESRD admissions. Results: Of 372,412 AMI-CS admissions, CKD-III, CKD-IV and ESRD comprised 20,380 (5.5%), 7367 (2.0%) and 18,109 (4.9%), respectively. Admissions with CKD were, on average, older, of the White race, bearing Medicare insurance, of a lower socioeconomic stratum, with higher comorbidities, and higher rates of acute organ failure. Compared to the cohort without CKD, CKD-III, CKD-IV and ESRD had lower use of coronary angiography (72.7%, 67.1%, 56.9%, 61.1%), PCI (53.7%, 43.8%, 38.4%, 37.6%) and MCS (47.9%, 38.3%, 33.3%, 34.2%), respectively (all p < 0.001). AKI and acute hemodialysis use increased with increase in CKD stage (no CKD–38.5%, 2.6%; CKD-III–79.1%, 6.5%; CKD-IV–84.3%, 12.3%; p < 0.001). ESRD (adjusted odds ratio [OR] 1.25 [95% confidence interval {CI} 1.21–1.31]; p < 0.001), but not CKD-III (OR 0.72 [95% CI 0.69–0.75); p < 0.001) or CKD-IV (OR 0.82 [95 CI 0.77–0.87] was predictive of in-hospital mortality. Conclusions: CKD/ESRD is associated with lower use of evidence-based therapies. ESRD was an independent predictor of higher in-hospital mortality in AMI-CS.

• acute myocardial infarction
• cardiogenic shock
• chronic kidney disease
• end-stage renal disease
• outcomes research

• adult
• female
• odds ratio
• shock, cardiogenic
• young adult

• Aged
• Aged, 80 and over
• Databases, Factual
• Female
• Health Status Disparities
• Hospital Costs
• Hospital Mortality
• Humans
• Length of Stay
• Male
• Retrospective Studies
• Sex Distribution
• Shock, Cardiogenic/mortality
• Shock, Cardiogenic/therapy
• United States/epidemiology

• UL1 TR000135 NCATS NIH HHS

• Coronary angiography
• Inter-hospital transfer
• Percutaneous coronary intervention
• ST-segment elevation myocardial infarction
• Thrombolytics

There are limited data on the seasonal variation in acute myocardial infarction (AMI) in the contemporary literature.

There would be decrease in the seasonal variation in the management and outcomes of AMI.

Adult (>18 years) AMI admissions were identified using the National Inpatient Sample (2000‐2017). Seasons were classified as spring, summer, fall, and winter. Outcomes of interest included prevalence, in‐hospital mortality, use of coronary angiography, and percutaneous coronary intervention (PCI). Subgroup analyses for type of AMI and patient characteristics were performed.

Of the 10 880 856 AMI admissions, 24.3%, 22.9%, 22.2%, and 24.2% were admitted in spring, summer, fall, and winter, respectively. The four cohorts had comparable age, sex, race, and comorbidities distribution. Rates of coronary angiography and PCI were slightly but significantly lower in winter (62.6% and 40.7%) in comparison to the other seasons (64‐65% and 42‐43%, respectively) (P < .001). Compared to spring, winter admissions had higher in‐hospital mortality (adjusted odds ratio [aOR]: 1.07; 95% confidence interval [CI]: 1.06‐1.08), whereas summer (aOR 0.97; 95% CI 0.96‐0.98) and fall (aOR 0.98; 95% CI 0.97‐0.99) had slightly lower in‐hospital mortality (P < .001). ST‐segment elevation (10.0% vs 9.1%; aOR 1.07; 95% CI 1.06‐1.08) and non‐ST‐segment elevation (4.7% vs 4.2%; aOR 1.07; 95% CI 1.06‐1.09) AMI admissions in winter had higher in‐hospital mortality compared to spring (P < .001). The primary results were consistent when stratified by age, sex, race, geographic region, and admission year.

Compared to other seasons, winter admission was associated with higher in‐hospital mortality in AMI in the United States.

• acute myocardial infarction
• healthcare disparities
• outcomes research
• season
• winter

• Acute cardiovascular care
• Cardiac arrest
• Cardiogenic shock
• Outcomes research
• ST-segment elevation myocardial infarction

• Adult
• Heart Arrest/therapy
• Hospital Mortality
• Humans
• Multiple Organ Failure
• ST Elevation Myocardial Infarction/complications
• ST Elevation Myocardial Infarction/therapy
• Shock, Cardiogenic/epidemiology
• Shock, Cardiogenic/etiology
• United States/epidemiology

• cardiology
• cells
• culture
• endothelium
• myocyte
• sex
• vascular smooth muscle

• Biomedical Research
• Cardiovascular System/cytology
• Cardiovascular System/physiopathology
• Cells, Cultured
• Female
• Humans
• Male
• Sex Factors

• K12 HD065987 NICHD NIH HHS
• U54 AG044170 NIA NIH HHS
• UL1 TR000135 NCATS NIH HHS

To assess the effects of weekend admission vs weekday admission on the management and outcomes of acute myocardial infarction (AMI).

Adult ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) hospital admissions were identified using the National (Nationwide) Inpatient Sample (2000-2016). Interhospital transfers were excluded. Timing of coronary angiography (CA) and percutaneous coronary intervention (PCI) relative to the day of admission was identified. Outcomes of interest included in-hospital mortality, receipt of early CA, timing of CA and PCI, resource utilization, and discharge disposition for weekend vs weekday admissions.

Of the 9,041,819 AMI admissions, 2,406,876 (26.6%) occurred on weekends. Compared with 2000, in 2016 there was an increase in weekend STEMI (adjusted odds ratio [aOR], 1.12; 95% CI, 1.08-1.16; P<.001) but not NSTEMI (aOR, 1.01; 95% CI, 0.98-1.02; P=.21) admissions. Compared with weekday admissions, weekend admissions received comparable CA (59.9% vs 58.8%) and PCI (38.4% vs 37.6%) and specifically lower rates of early CA (hospital day 0) (26.0% vs 20.8%; P<.001). There was a steady increase in CA and PCI use during the 17-year period. Mean ± SD time to CA was higher in the weekend group vs the weekday group (1.2±1.8 vs 1.0±1.8 days; P<.001). Weekend admission did not influence in-hospital mortality (aOR, 1.01; 95% CI, 1.00-1.01; P=.05) but had fewer discharges to home (58.7% vs 59.7%; P<.001).

Despite small differences in CA and PCI, there were no differences in in-hospital mortality of AMI admissions on weekdays vs weekends in the United States in the contemporary era.

• AMI, acute myocardial infarction
• HCUP, Healthcare Cost and Utilization Project
• NIS, National (Nationwide) Inpatient Sample
• NSTEMI, non–ST-segment elevation myocardial infarction
• OR, odds ratio
• PCI, percutaneous coronary intervention
• STEMI, ST-segment elevation myocardial infarction

The aim of this study is to evaluate the contemporary use of a pulmonary artery catheter (PAC) in acute myocardial infarction‐cardiogenic shock (AMI‐CS).

A retrospective cohort of AMI‐CS admissions using the National Inpatient Sample (2000–2014) was identified. Admissions with concomitant cardiac surgery or non‐AMI aetiology for cardiogenic shock were excluded. The outcomes of interest were in‐hospital mortality, resource utilization, and temporal trends in cohorts with and without PAC use. In the non‐PAC cohort, the use and outcomes of right heart catheterization was evaluated. Multivariable regression and propensity matching was used to adjust for confounding. During 2000–2014, 364 001 admissions with AMI‐CS were included. PAC was used in 8.1% with a 75% decrease during over the study period (13.9% to 5.4%). Greater proportion of admissions to urban teaching hospitals received PACs (9.5%) compared with urban non‐teaching (7.1%) and rural hospitals (5.4%); P < 0.001. Younger age, male sex, white race, higher comorbidity, noncardiac organ failure, use of mechanical circulatory support, and noncardiac support were independent predictors of PAC use. The PAC cohort had higher in‐hospital mortality (adjusted odds ratio 1.07 [95% confidence interval 1.04–1.10]), longer length of stay (10.9 ± 10.9 vs. 8.2 ± 9.3 days), higher hospitalization costs ($128 247 ± 138 181 vs. $96 509 ± 116 060), and lesser discharges to home (36.3% vs. 46.4%) (all P < 0.001). In 6200 propensity‐matched pairs, in‐hospital mortality was comparable between the two cohorts (odds ratio 1.01 [95% confidence interval 0.94–1.08]). Right heart catheterization was used in 12.5% of non‐PAC admissions and was a marker of greater severity but did not indicate worse outcomes.

In AMI‐CS, there was a 75% decrease in PAC use between 2000 and 2014. Admissions receiving a PAC were a higher risk cohort with worse clinical outcomes.

• Acute myocardial infarction
• Cardiac intensive care unit
• Cardiogenic shock
• Critical care cardiology
• Heart failure
• Pulmonary artery catheterization
• Right heart catheterization

Background: There are limited data on complications in acute myocardial infarction (AMI) admissions receiving extracorporeal membrane oxygenation (ECMO). Methods: Adult (>18 years) admissions with AMI receiving ECMO support were identified from the National Inpatient Sample database between 2000 and 2016. Complications were classified as vascular, lower limb amputation, hematologic, and neurologic. Outcomes of interest included temporal trends, in-hospital mortality, hospitalization costs, and length of stay. Results: In this 17-year period, in ~10 million AMI admissions, ECMO support was used in 4608 admissions (<0.01%)—mean age 59.5 ± 11.0 years, 75.7% men, 58.9% white race. Median time to ECMO placement was 1 (interquartile range [IQR] 0–3) day. Complications were noted in 2571 (55.8%) admissions—vascular 6.1%, lower limb amputations 1.1%, hematologic 49.3%, and neurologic 9.9%. There was a steady increase in overall complications during the study period (21.1% in 2000 vs. 70.5% in 2016). The cohort with complications, compared to those without complications, had comparable adjusted in-hospital mortality (60.7% vs. 54.0%; adjusted odds ratio 0.89 [95% confidence interval 0.77–1.02]; p = 0.10) but longer median hospital stay (12 [IQR 5–24] vs. 7 [IQR 3–21] days), higher median hospitalization costs ($458,954 [IQR 260,522–737,871] vs. 302,255 [IQR 173,033–623,660]), fewer discharges to home (14.7% vs. 17.9%), and higher discharges to skilled nursing facilities (44.1% vs. 33.9%) (all p < 0.001). Conclusions: Over half of all AMI admissions receiving ECMO support develop one or more severe complications. Complications were associated with higher resource utilization during and after the index hospitalization.

• acute myocardial infarction
• complications
• extracorporeal membrane oxygenation
• hemorrhage
• vascular

• coronary angiography
• hospitalization
• length of stay
• myocardial infarction
• percutaneous coronary intervention