CRT-100.38 Shock Protocols May Decrease Racial, Ethnic, and Sex Disparities in Acute Myocardial Infarction and Cardiogenic Shock

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Background: There are significant racial, ethnic and sex differences in procedural utilization and clinical outcomes in patients with acute myocardial infarction and cardiogenic shock (AMICS). We sought to assess if these differences improved with the use of a shock protocol. Methods: The National Cardiogenic Shock Initiative ( Identifier: NCT03677180) is a single-arm, prospective, multi-center study assessing outcomes associated with the early use of mechanical circulatory support (MCS) guided by invasive hemodynamics in patients presenting with AMICS treated with percutaneous coronary intervention. Between July 2016 and November 2020, 73 sites participated and enrolled into the study. Patient demographics, admission and procedural characteristics, hemodynamics and outcomes were analyzed based on race, ethnicity and sex. Results: 406 patients were included (32% non-White, 24% Women). Non-White patients were younger (62 vs 65 years, p=0.03) and more likely to have diabetes (52 vs 35%, p<0.01), end-stage renal disease (ESRD) (7 vs 2%, p=0.01), chronic kidney disease (20 vs 9%, p<0.01) and heart failure (31 vs 19%, p=0.01). Non-White patients were also more likely to have MCS support placed while undergoing cardio-pulmonary resuscitation (13 vs 7%, p=0.05). Women were older (66 vs 63, p=0.01), more likely to have diabetes (51 vs 37, p=0.02) and ESRD (7 vs 3%, p=0.03), and more likely to have an Impella 2.5 placed (p<0.01). After adjusting for age, past medical history and shock stage, multivariate regression analysis demonstrated no difference in mortality based on race, ethnicity or sex at discharge (Race/Ethnicity, OR 1.09 (0.62-1.91), p=0.77; Sex, OR 0.88 (0.47-1.64), p=0.69); at 30 days (Race/Ethnicity, OR 1.33 (0.76-2.34), p=0.32; Sex, OR 0.87 (0.46-1.61), p=0.65) or at 1-year (Race/Ethnicity, OR 1.58 (0.85-2.96), p=0.15; Sex, OR 0.94 (0.48-1.82), p=0.86). Conclusion: When treated using a standardized shock protocol, minorities and women had similar outcomes compared to white patients and men. Utilization of shock protocols may be an important mechanism to reduce disparities in patients with AMICS.

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