Abstract
Background/Introduction
ST segment elevation myocardial infarction (STEMI) is a frequent cause of Cardiac Arrest (CA), and early percutaneous coronary intervention is associated with increased hospital survival in these patients. Despite constant improvements in out-of-hospital CA management, survival remains low.
Purpose
Our aim was to assess pre-admission CA incidence, predictors and related outcomes in patients admitted with STEMI.
Methods
We prospectively included 1083 patients admitted with STEMI in a tertiary university hospital in southern Brazil between March 2011 and October 2019. All patients were submitted to emergency coronary angiography. Baseline characteristics, details of the procedure, reperfusion strategies, and in-hospital outcomes were evaluated.
Results
Mean age was 60.8 years (± 12), 66.2% were male, 62% had hypertension and 25.3% had diabetes. Pre-admission CA was present in 104 (9.8%) patients. Patients with CA had more frequently previous myocardial infarction, temporary pacemaker, smoking and Killip 3 or 4 on admission, and shorter pain–to-door time than patients without CA. In addition, CA patients had a higher incidence of periprocedural CA, cardiogenic shock and periprocedural and in-hospital mortality. In multivariate analysis, age (RR= 0.96, p=0.001), anterior MI (RR=1.67, p=0.04) smoking (RR=0.57, p=0.04), previous ASA use (RR=0.40, p=0.02), Killip 3 or 4 (RR=14.71, p<0.001), temporary pacemaker (RR 2.53, p=0.01), pain-to-door time (RR=0.99, p=0.017) were independently associated with CA. Non Shockable Rhythm (RR=7.37, p=0.017), ROSC duration (RR=1.05, p=0.02) and cardiogenic shock (RR=31.2, p=0.003) were independent predictors of mortality among patients admitted with CA.
Conclusion
In this cohort of consecutive patients admitted with STEMI, pre-admission CA incidence was greater than seen in literature. Cardiogenic shock and in-hospital mortality were more common in patients admitted with CA, which may in part explain our higher rate of overall in-hospital mortality. Non shockable rhythm, increased ROSC and cardiogenic shock were independent predictors of mortality among patients admitted with CA. Understanding these characteristics may help taking measures to lower mortality rates.
Funding Acknowledgement
Type of funding source: None
Epidemiology of cardiogenic shock and cardiac arrest complicating non‐ST‐segment elevation myocardial infarction: 18‐year US study
