DanGer shock eligibility, outcomes, and costs in acute myocardial infarction
S Higuchi, S Kohsaka, Y Sumita, K Kanaoka, Y Yokota, H Matsumoto, T ShinkeAbstract
Background
In-hospital mortality remains 45 % in patients with acute myocardial infarction (AMI)-related cardiogenic shock. Benefits of mechanical circulatory support (MCS), including an axial flow pump and venoarterial extracorporeal membrane oxygenation, are limited.
Purpose
This study aimed to identify AMI patients likely to benefit from MCS using DanGer Shock eligibility and to clarify the actual medical costs of patients treated with MCS.
Methods
Using the Japanese nationwide administrative dataset (JROAD-DPC) from 2022 to 2023, the associations of DanGer Shock eligibility with in-hospital mortality, failure of discharge to home, and medical costs were evaluated. DanGer Shock eligibility was defined by the absence of mechanical complications, out-of-hospital cardiac arrest with persistent coma, and severe dementia.
Results
Of 52,927 AMI patients, 2,223 were treated with MCS. Among these patients, in-hospital death and failure of discharge to home occurred in 1,338 (DanGer Shock–eligible, 944; ineligible, 394) and 379 (DanGer Shock–eligible, 281; ineligible, 98), respectively. DanGer Shock eligibility was associated with lower in-hospital mortality (adjusted odds ratio [aOR], 0.58; 95% confidence interval [CI], 0.47–0.73) and lower failure of discharge to home (aOR, 0.37; 95% CI, 0.25–0.54). Among survivors and those discharged to home, DanGer Shock ineligibility was associated with higher medical costs (eligible survivors, €36,700 [28,400–49,300]; ineligible survivors, €41,000 [28,400–58,200]; p = 0.058; eligible survivors discharged to home, €33,400 [27,400–42,300]; ineligible survivors discharged to home, €38,800 [26,600–53,100]; p = 0.063). In contrast, among patients who died, medical costs were higher in eligible than ineligible patients (€26,300 [13,500–44,200] vs. €23,000 [12,600–39,800]; p = 0.032). There was no significant difference in medical costs between eligible and ineligible survivors who were not discharged to home (p = 0.570).
Conclusions
DanGer Shock ineligibility identified AMI patients at high risk of in-hospital mortality and failure of discharge to home. DanGer Shock–ineligible patients incurred substantial medical costs, underscoring the need for careful consideration of MCS use in this population.Figure 1Figure 2