Age-Based Temporal Trends of In-Hospital Outcomes for Cardiogenic Shock Treated With Impella After Acute Myocardial Infarction

Background/Significance:

The impact of age on temporal trends in in-hospital outcomes for cardiogenic shock (CS) patients requiring Impella support after acute myocardial infarction (AMI) is unclear.

Purpose:

To evaluate age-related differences and temporal trends in in-hospital outcomes among patients with cardiogenic shock requiring Impella support following acute myocardial infarction using a nationally representative dataset in order to identify gaps in outcomes and inform age-specific management strategies.

Methods:

The National Inpatient Sample from 2016 to 2020 was used to identify the cohort. Patients who required both intra-aortic balloon pump and Impella were excluded. Patients were categorized into 3 age groups: 18-64, 65-79, and ≥80 years. Linear and logistic regression analyses were performed with the year as a continuous variable to assess temporal trends.

Results:

Of 3,109,934 adult AMI patients, 210,395 (6.7%) had CS. Of these, 25,950 (12.7%) required Impella support. There was no significant reduction in in-hospital mortality over time in any age group; however, patients aged ≥80 consistently exhibited the highest mortality rates. Notably, the 18-64 age group had the longest overall hospital stay, and only the ≥80 group showed a significant decrease in length of stay over time (P=0.04). The risk-adjusted odds of in-hospital mortality were significantly higher in the 65-79 group (AOR 1.84, P

Conclusion:

In-hospital mortality for CS patients requiring Impella after AMI has not improved, with the elderly particularly at high risk. These findings underscore the need to consider age in therapy decisions and emphasize the importance of shared decision-making.