Accepted Manuscript Outcomes with Invasive versus Conservative Management of Cardiogenic Shock Complicating Acute Myocardial Infarction Sripal Bangalore, MD, MHA, Navdeep Gupta, MD, Yu Guo, MA, Anuradha Lala, MD, Leora Balsam, MD, Robert O. Roswell, MD, Alex Reyentovich, MD, Judith S. Hochman, MD PII:

S0002-9343(14)01227-3

DOI:

10.1016/j.amjmed.2014.12.009

Reference:

AJM 12821

To appear in:

The American Journal of Medicine

Received Date: 17 December 2014 Revised Date:

21 December 2014

Accepted Date: 22 December 2014

Please cite this article as: Bangalore S, Gupta N, Guo Y, Lala A, Balsam L, Roswell RO, Reyentovich A, Hochman JS, Outcomes with Invasive versus Conservative Management of Cardiogenic Shock Complicating Acute Myocardial Infarction, The American Journal of Medicine (2015), doi: 10.1016/ j.amjmed.2014.12.009. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

ACCEPTED MANUSCRIPT

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Outcomes with Invasive versus Conservative Management of Cardiogenic Shock Complicating Acute Myocardial Infarction

Sripal Bangalore, MD, MHA, Navdeep Gupta, MD, Yu Guo, MA, Anuradha Lala, MD, Leora Balsam, MD, Robert O. Roswell, MD, Alex Reyentovich, MD, Judith S. Hochman, MD

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New York University School of Medicine, New York, NY (SB, AR, YG, ROR, LB, AL, JSH); Medical College of Wisconsin, Milwaukee, WI (NG);

Word Count: 3214

Conflict of Interest: None

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Running title: Outcomes in cardiogenic shock

All authors had access to the data and a role in writing the manuscript.

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Funding: None

Correspondence: Sripal Bangalore, MD, MHA, FACC, FAHA, FSCAI Director of Research, Cardiac Catheterization Laboratory, Director, Cardiovascular Outcomes Group, Associate Professor of Medicine, New York University School of Medicine, New York, NY 10016. Email: [email protected] Ph: 212 263 3540 Fax: 212 263 3988 1

ACCEPTED MANUSCRIPT

Abstract Background: In the SHOCK trial an invasive strategy of early revascularization was associated with a significant mortality benefit at 6-months when compared with initial stabilization in

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patients with cardiogenic shock complicating acute myocardial infarction. Our objectives were to evaluate the data on real world practice and outcomes of invasive vs. conservative management

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in patients with cardiogenic shock.

Methods: We analyzed data from the Nationwide Inpatient Sample (NIS) between 2002 to 2011

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with primary discharge diagnosis of acute myocardial infarction and secondary diagnosis of cardiogenic shock. Propensity score matching was used to assemble a cohort of patients managed invasively (with cardiac catheterization, percutaneous coronary intervention or coronary artery bypass graft surgery) vs. conservatively with similar baseline characteristics. The

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primary outcome was in-hospital mortality.

Results: We identified 60833 patients with cardiogenic shock of which 20644 patients (10322 in

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each group) with similar propensity scores, including 11,004 elderly patients (≥ 75 years), were in the final analysis. Patients who underwent invasive management had a 59% lower odds of in-

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hospital mortality (37.7% vs. 59.7%; OR=0.41; 95% CI 0.39-0.43; P