Adult admissions with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) were extracted from the National Inpatient Sample database (2005 to 2017) and separated into quartiles based on the median household income of each zip code (0 to 25th, 26th to 50th, 51st to 75th, and 76th to 100th). In-hospital mortality, cardiac and noncardiac procedures, utilization, and consumption of resources were examined across all 4 income quartiles. Cardiogenic shock was found in 409,294 admissions (5.2%) out of 7,805,681 AMI admissions, and its prevalence was equivalent across all 4 economic quartiles. However, they had lesser use of early coronary angiography, early percutaneous coronary intervention, mechanical circulatory support devices, and pulmonary artery catheterization than admissions from the higher earning quartiles. In the adjusted analysis, admissions belonging to the 0 to 25th income quartile (odds ratio [OR] 1.17 [95% CI 1.15 to 1.20], P<0.001), 26th to 50th quartile (OR 1.11 [95% CI 1.09 to 1.14], P<0.001), and 51st to 75th income quartile (OR 1.06 [95% CI 1.04 to 1.09], P<0.001) had higher adjusted in-hospital mortality than the highest income quartile (76th to 100th). Compared with the higher income quartiles, the lowest income quartile had a lower rate of palliative care consultations and a greater percentage of do-not-resuscitate orders. AMI-CS admissions in the lowest income quartile were connected to a higher prevalence of non-ST-elevation myocardial infarction, reduced usage of mechanical circulatory support devices, and higher in-hospital death rates.

Source – ajconline.org/article/S0002-9149(22)00518-5/fulltext