Background:
In the emergent setting of ST-Elevation Myocardial Infarction (STEMI) complicating out-of-hospital cardiac arrest (OHCA), decisions for immediate coronary angiography are made when the likelihood of hospital survival is unknown. Estimating the risk of mortality at the time of hospital arrival might inform decisions for primary percutaneous coronary intervention.
Methods:
From the Cardiac Arrest Registry to Enhance Survival (CARES), we included adult OHCA patients from 2013-2018 presenting to hospitals with a STEMI. We developed a predictive model for in-hospital mortality using multivariable logistic regression to derive a scoring tool that was internally validated with bootstrap methods.
Results:
Of 7120 patients with OHCA and STEMI admitted at a hospital (mean age 62±13.2 years, 27% female), 3159 (44.4%) died during hospitalization. Higher age, unwitnessed arrest, non-shockable cardiac arrest rhythm, no sustained return of spontaneous circulation (ROSC) at the time of hospital admission, and resuscitation time on scene were most predictive of mortality (C-index, 0.82). Using the model β coefficients, we developed an integer risk score ranging from 0 to 10 points, corresponding to observed mortality rates of 5% to 100% (Figure 1). The odds of in-hospital mortality doubled for each 1-unit score increase (odds ratio, 2.01; 95% CI, 1.94-2.09; p<0.0001), and a score of ≥6, involving ~15% of patients, was associated with ≥85% in-hospital mortality risk.
Conclusions:
This risk score, based on simple prehospital characteristics, stratifies the range of in-hospital mortality from 5% to nearly 100% in OHCA patients with STEMI at the time of hospital presentation. The benefits of such a model in decision-making for immediate coronary angiography should be prospectively studied.
A Risk-Adjustment Model for Patients Presenting to Hospitals with Out-of-Hospital Cardiac Arrest and ST-Elevation Myocardial Infarction
