(202) Impact of Pulmonary Hypertension on Outcomes of Acute Myocardial Infarction and Cardiogenic Shock

Introduction: Cardiogenic shock is a major contributor to in-hospital mortality following acute myocardial infarction (MI). While pulmonary hypertension (PH) has been linked to worse outcomes in non-cardiac surgeries, the impact on patients experiencing cardiogenic shock, specifically in cases of acute MI remains unclear. Limited data exists on how PH affects inpatient outcomes in individuals with acute myocardial infarction complicated by cardiogenic shock. Therefore, our study aims to investigate and compare the inpatient outcomes of patients with acute myocardial infarction complicated by cardiogenic shock and concomitant PH to those without PH.

Methods: Based on National Inpatient Sample Database, patients admitted with acute MI and cardiogenic shock were identified and divided into 2 groups based on the presence or absence of PH. Clinical characteristics and in-hospital outcomes were compared.

Results: Between 2016 and 2020, we identified 30,032 patients admitted with acute MI and cardiogenic shock. 3,469 patients had concomitant pulmonary hypertension. After performing 1:1 propensity matching, we found no significant difference in mortality. However, a notable disparity was observed in the utilization of various procedures, with percutaneous coronary intervention (OR:1.37; 95% CI:1.17-1.59; P < 0.05), Impella (OR:1.37; 95% CI:1.17-1.60; P < 0.05) being more frequently employed in patients without pulmonary. Furthermore, patients with PH experienced a significantly longer length of hospital stay (LOS) compared to those without PH. Interestingly, non-ST segment elevation MI (NSTEMI) was found to be statistically more prevalent among patients with PH, while ST segment elevation MI (STEMI) was more commonly observed in those without PH.

Conclusions: In patients with acute MI complicated by cardiogenic shock, the presence of pulmonary hypertension (PH) was associated with higher morbidities with increased length of hospital stay and decreased procedural interventions. No difference in in-hospital mortality was observed. NSTEMI was more prevalent in patients with PH, while STEMI was more common in those without PH. Further studies are needed to clarify the clinical and prognostic implications of PH in this context.