BACKGROUND There are limited data on volume-outcome relationships in acute myocardial infarction (AMI) with cardiogenic shock (CS). OBJECTIVES In this study, the authors sought to evaluate the association between hospital percutaneous coronary intervention (PCI) volume and readmission after AMI-CS. METHODS Adult AMI-CS patients were identified from the Nationwide Readmissions Database for 2016-2019 and were categorized into hospital quartiles (Q1 lowest volume to Q4 highest) based on annual inpatient PCI volume. Outcomes of interest included 30-day all-cause, cardiac, noncardiac, and heart-failure (HF) readmissions. RESULTS There were 49,558 AMI-CS admissions at 3,954 PCI-performing hospitals. Median annual PCI volume was 174 (Q1-Q3: 70-316). Patients treated at Q1 hospitals were on average older, female, and with higher comorbidity burden. Patients at Q4 hospitals had higher rates of noncardiac organ dysfunction, complications, and use of cardiac support therapies. Overall, 30-day readmission rate was 18.5% (n = 9,179), of which cardiac, noncardiac, and HF readmissions constituted 56.2%, 43.8%, and 25.8%, respectively. From Q1 to Q4, there were no differences in 30-day all-cause (17.6%, 18.4%, 18.2%, 18.7%; P = 0.55), cardiac (10.9%, 11.0%, 10.6%, 10.2%; P = 0.29), and HF (5.0%, 4.8%, 4.8%, 4.8%; P = 0.99) readmissions. Noncardiac readmissions were noted more commonly in higher quartiles (6.7%, 7.4%, 7.7%, 8.5%; P = 0.001) but was not significant after multivariable adjustment. No relationship was noted between hospital PCI volume as a continuous variable and readmissions. CONCLUSIONS In AMI-CS, there was no association between hospital annual PCI volume and 30-day readmissions despite higher acuity in the higher volume PCI centers suggestive of better care pathways for CS at higher volume centers.

中文翻译：

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住院患者经皮冠状动脉介入治疗量对急性心肌梗死-心源性休克后 30 天再入院的影响。


背景 关于急性心肌梗死（AMI）合并心源性休克（CS）的容量与结果关系的数据有限。目的 在这项研究中，作者试图评估医院经皮冠状动脉介入治疗 (PCI) 量与 AMI-CS 后再入院之间的关系。方法 从 2016-2019 年全国再入院数据库中确定成人 AMI-CS 患者，并根据年度住院 PCI 患者量分为医院四分位数（第一季度最低量至第四季度最高量）。感兴趣的结果包括 30 天全因、心脏、非心脏和心力衰竭 (HF) 再入院。结果 3,954 家开展 PCI 的医院共有 49,558 名 AMI-CS 入院患者。年 PCI 数量中位数为 174（第一季度至第三季度：70-316）。在 Q1 医院接受治疗的患者平均年龄较大、女性且合并症负担较高。第四季度医院的患者非心脏器官功能障碍、并发症和心脏支持治疗的使用率较高。总体而言，30 天再入院率为 18.5%（n = 9,179），其中心源性、非心源性和心力衰竭再入院率分别为 56.2%、43.8% 和 25.8%。从第一季度到第四季度，30 天全因（17.6%、18.4%、18.2%、18.7%；P = 0.55）、心脏疾病（10.9%、11.0%、10.6%、10.2%；P = 0.29）和心衰（5.0%、4.8%、4.8%、4.8%；P = 0.99）再入院。非心源性再入院在较高四分位数中更为常见（6.7%、7.4%、7.7%、8.5%；P = 0.001），但经过多变量调整后并不显着。作为连续变量的医院 PCI 数量与再入院之间没有发现任何关系。 结论 在 AMI-CS 中，医院年度 PCI 数量与 30 天再入院率之间不存在关联，尽管数量较多的 PCI 中心的敏锐度较高，表明数量较多的中心有更好的 CS 护理途径。