Impact of Social Determinants of Health on Utilization of Mechanical Circulatory Support Device in STEMI With Cardiogenic Shock

Background: Cardiogenic shock (CS) is a severe complication of ST-elevation myocardial infarction (STEMI) with high mortality despite advancements in treatment.Mechanical circulatory support (MCS) devices, such as extracorporeal membrane oxygenation, Impella, and intraaortic balloon pump, have shown promise in improving outcomes but remain underutilized, especially among minority populations and women.This study evaluated disparities in MCS utilization among STEMI-CS patients based on sex, race, and socioeconomic factors.Methods: We analyzed data from the Nationwide Inpatient Sample between 2016 and 2021, identifying patients with STEMI-CS using International Classification of Diseases, Tenth Revision codes.Patients were stratified based on MCS utilization.Sociodemographic and hospital characteristics were compared, and multivariate logistic regression and propensity score matching were applied to evaluate disparities and outcomes.Results: Among 140,820 patients with STEMI-CS, 18.8% received MCS.MCS recipients were younger, predominantly male (74.2% vs 65.1%; P < .001),and more likely to be treated at urban teaching hospitals (81.8% vs 75%; P < .001).Female patients had 30% lower odds of receiving MCS (adjusted odds ratio [aOR], 0.70; 95% CI, 0.65-0.76;P < .001),while African American (aOR, 0.85; 95% CI, 0.75-0.97;P .016)and Asian (aOR, 0.70; 95% CI, 0.58-0.85;P < .001)patients were less likely to receive MCS than White patients.Medicaid recipients and rural hospital patients also had reduced odds of MCS utilization.Subgroup analysis revealed racial disparities in MCS utilization among men but not women.MCS use was associated with longer hospital stays (9 vs 7 days) and higher costs ($433,201 vs $191,121).Conclusions: This study highlights significant disparities in MCS utilization among STEMI-CS patients, driven by sex, race, and socioeconomic factors.These findings underscore the need for targeted interventions to address health care inequities and improve outcomes in this high-risk population.