Incidence, predictors and prognosis of respiratory support in non-ST segment elevation myocardial infarction

Thomas Metkus; P Elliott Miller; Carlos L Alviar; Jacob C Jentzer; Sean van Diepen; Jason N Katz; David A Morrow; Steven Schulman; Shaker Eid

doi:10.1177/2048872620919947

Incidence, predictors and prognosis of respiratory support in non-ST segment elevation myocardial infarction

Eur Heart J Acute Cardiovasc Care. 2020 Apr 23:2048872620919947. doi: 10.1177/2048872620919947. Online ahead of print.

Authors

Thomas Metkus¹, P Elliott Miller², Carlos L Alviar³, Jacob C Jentzer⁴, Sean van Diepen⁵, Jason N Katz^{6

7}, David A Morrow⁷, Steven Schulman¹, Shaker Eid¹

Affiliations

¹ Department of Medicine, Johns Hopkins University School of Medicine, USA.
² Department of Cardiovascular Medicine, Yale School of Medicine, USA.
³ Leon H. Charney Division of Cardiology, New York University School of Medicine, USA.
⁴ Department of Cardiovascular Medicine, The Mayo Clinic, USA.
⁵ Department of Critical Care and Division of Cardiology and Department of Medicine, University of Alberta Canada.
⁶ Division of Cardiology, Duke University, Durham, NC USA.
⁷ TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

PMID: 32324057
DOI: 10.1177/2048872620919947

Abstract

Background: The incidences of invasive mechanical ventilation and non-invasive ventilation among patients with non-ST segment elevation myocardial infarction and associated prognosis are not well characterized.

Methods: We conducted a retrospective cohort study of patients with admission diagnosis of non-ST segment elevation myocardial infarction using the US National Inpatient Sample database between 2002-2014. The exposure variable was invasive mechanical ventilation or non-invasive ventilation within 24 h of admission, compared to no respiratory support. The primary outcome was in-hospital mortality. We determined the association between respiratory support and mortality using Cox proportional hazard models.

Results: A total of 4,152,421 non-ST segment elevation myocardial infarction hospitalizations were identified, among whom 1.3% required non-invasive ventilation and 1.9% required invasive mechanical ventilation. Non-invasive ventilation use increased over time (0.4% in 2002 to 2.4% in 2014, p<0.001) while there was no definite trend in invasive mechanical ventilation use. Revascularization was lower for non-ST segment elevation myocardial infarction hospitalizations including invasive mechanical ventilation (23.9%) and non-invasive ventilation (14.5%) compared to 36.5% of those without respiratory support (p<0.001). In-hospital mortality was 3.1% for non-ST segment elevation myocardial infarction without respiratory support compared to 9.2% with non-invasive ventilation (adjusted hazard ratio 1.86, 95% confidence interval 1.74-1.98) and 37.2% with invasive mechanical ventilation (adjusted hazard ratio 3.03, 95% confidence interval 2.88-3.19). Mortality for non-ST segment elevation myocardial infarction-non-invasive ventilation is improving over time while mortality for non-ST segment elevation myocardial infarction-invasive mechanical ventilation is increasing over time.

Conclusion: Mechanical respiratory support in non-ST segment elevation myocardial infarction is used in an important minority of cases, is increasing and is independently associated with mortality. Studies of the optimal management of acute coronary syndrome complicated by respiratory failure are needed to improve outcomes.

Keywords: Acute coronary syndrome; mechanical ventilation; non-ST segment elevation myocardial infarction; non-invasive ventilation; respiratory failure.