ASSOCIATION OF ACUTE MYOCARDIAL INFARCTION CARDIAC ARREST PATIENT VOLUME AND IN-HOSPITAL MORTALITY

Introduction: Racial disparities in outcomes of acute myocardial infarction (AMI) and cardiac arrest (CA) exist. This study assessed the racial differences in the management and outcomes of CA complicating AMI to better inform clinical care. Hypothesis: We hypothesized that racial minorities would have worse outcomes with AMI-CA as compared to white patients. Methods: During 2012-2017, AMI admissions with a concomitant diagnosis of CA were identified from the National Inpatient Sample. Race was classified as white, black and others (Hispanic, Asian or Pacific Islander, Native American, Others). The primary outcome was racial disparities in in-hospital mortality. Secondary outcomes included racial disparities in invasive procedures and hospitalization characteristics. Results: We identified 3,504,225 admissions for AMI in the study period, of which 182,750 (5.2%) were complicated by CA. 74.8% were white, 10.7% were black and 14.5% belonged to other races. Black and other race AMI-CA admissions received less frequent early coronary angiography (41.4% vs 50.2% vs 52.8%), coronary angiography (61.9% vs 70.2% vs. 73.1% %), PCI (44.6% vs 53.0% vs 58.1%), CABG and mechanical circulatory support compared to white and other races. The mean time to coronary angiography was highest among blacks (3.4 ± 4.2 days) and lowest among whites (3.0 ± 3.7 days). Black and other races had significantly higher unadjusted mortality, however in a multivariable logistic regression analysis with white race as referent, black race was associated with lower in-hospital mortality (OR 0.95 [95% CI 0.91-0.99]; p =0.007) whereas other races had higher in-hospital mortality (OR 1.11 [95% CI 1.08-1.15]; p <0.001) compared to white race. AMI-CA admissions of black race had longer length of hospital stay, higher rates of palliative care consultation, less frequent DNR status use, and fewer discharges to home. Admissions of other races had higher use of DNR status and higher hospitalization costs compared to whites and blacks. Conclusions: Significant racial disparities exist in in-hospital mortality among AMI admissions complicated with CA. Further quantitative and qualitative research into the equitable care of racial minorities with AMI-CA is needed to address this disparity.

Download Full-text

Percutaneous Coronary Intervention After Return of Spontaneous Circulation Reduces the In-Hospital Mortality in Patients with Acute Myocardial Infarction Complicated by Cardiac Arrest

International Journal of General Medicine ◽

10.2147/ijgm.s326737 ◽

2021 ◽

Vol Volume 14 ◽

pp. 7361-7369

Author(s):

Jingcong Zhang ◽

Haixia Xiong ◽

Jie Chen ◽

Qiuping Zou ◽

Xiaoxing Liao ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Cardiac Arrest ◽

Hospital Mortality ◽

Coronary Intervention ◽

Spontaneous Circulation ◽

Return Of Spontaneous Circulation ◽

Percutaneous Coronary

Download Full-text

Seasonal variation in the management and outcomes of cardiac arrest complicating acute myocardial infarction

QJM ◽

10.1093/qjmed/hcab246 ◽

2021 ◽

Author(s):

S H Patlolla ◽

A Kanwar ◽

P R Sundaragiri ◽

W Cheungpasitporn ◽

R P Doshi ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiac Arrest ◽

Coronary Angiography ◽

Hospital Mortality ◽

Length Of Hospital Stay ◽

The United States ◽

Hospital Length Of Stay ◽

Discharge Disposition ◽

Hospitalization Costs

Summary Background There are limited data on the influence of seasons on the outcomes of acute myocardial infarction-cardiac arrest (AMI-CA). Aim To evaluate the outcomes of AMI-CA by seasons in the United States Design Retrospective cohort study Methods Using the National Inpatient Sample from 2000 to 2017, adult (>18 years) admissions with AMI-CA were identified. Seasons were defined by the month of admission as spring, summer, fall and winter. The outcomes of interest were prevalence of AMI-CA, in-hospital mortality, use of coronary angiography, percutaneous coronary intervention (PCI), hospital length of stay, hospitalization costs and discharge disposition. Results Of the 10 880 856 AMI admissions, 546 334 (5.0%) were complicated by CA, with a higher prevalence in fall and winter (5.1% each) compared to summer (5.0%) and spring (4.9%). Baseline characteristics of AMI-CA admissions admitted in various seasons were largely similar. Compared to AMI-CA admissions in spring, summer and fall, AMI-CA admissions in winter had slightly lower rates of coronary angiography (63.3–64.3% vs. 61.4%) and PCI (47.2–48.4% vs. 45.6%). Compared to those admitted in the spring, adjusted in-hospital mortality was higher for winter {46.8% vs. 44.2%; odds ratio (OR) 1.08 [95% confidence interval (CI) 1.06–1.10]; P < 0.001}, lower for summer [43% vs. 44.2%; OR 0.97 (95% CI 0.95–0.98); P < 0.001] and comparable for fall [44.4% vs. 44.2%; OR 1.01 (95% CI 0.99–1.03); P = 0.31] AMI-CA admissions. Length of hospital stay, total hospitalization charges and discharge dispositions for AMI-CA admissions were comparable across the seasons. Conclusions AMI-CA admissions in the winter were associated with lower rates of coronary angiography and PCI, and higher rates of in-hospital mortality compared to the other seasons.

Download Full-text

Changes in clinical features and outcomes in three major critical diseases after COVID-19 pandemic: acute myocardial infarction, stroke, and cardiac arrest

10.22514/sv.2021.250 ◽

2021 ◽

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiac Arrest ◽

Ischemic Stroke ◽

Hospital Mortality ◽

Hemorrhagic Stroke ◽

Moving Average ◽

Multivariable Logistic Regression Analysis ◽

Number Of Patients ◽

Post Period

A few months after the onset of the coronavirus Disease 2019 (COVID-19) pandemic, the worse prognoses of acute myocardial infarction, ischemic and hemorrhagic stroke, and cardiac arrest were reported. This study aimed to investigate the changes in the characteristics and prognoses of these diseases in the emergency department (ED) over a year after pandemic’s onset. This was a retrospective observational study. The year 2019 was defined as the pre-period, while the year from February 2020 to January 2021 was defined as the post-period. Adult patients diagnosed with acute myocardial infarction, ischemic stroke, hemorrhagic stroke, or cardiac arrest during the study period were included. The primary outcome was in-hospital mortality. Time series analyses using autoregressive integrated moving average (ARIMA)(p,d,q) model were performed to evaluate the changes between periods. A multivariable logistic regression analysis of factors affecting in-hospital mortality was performed. The proportions of patients with acute myocardial infarction (0.8% vs. 1.1%, p < 0.001), hemorrhagic stroke (1.0%vs. 1.2%, p = 0.011), and cardiac arrest (0.9% vs. 1.1%, p = 0.012) increased in the post-period. The post-period was independently associated with in-hospital mortality in acute myocardial infarction (adjusted odds ratio (aOR) 2.54, 95% confidence interval (95% CI) 1.06–6.08, p = 0.037) and hemorrhagic stroke (aOR 1.74, 95% CI 1.11–2.73, p = 0.016), but not for ischemic stroke or cardiac arrest. Over a year after onset of the COVID-19 pandemic in Korea, the number of patients with acute myocardial infarction, hemorrhagic stroke, and cardiac arrest in the ED increased. An independent association between the post-period and mortality was observed for acute myocardial infarction, and hemorrhagic stroke. This study provides important information for future studies and policies.

Download Full-text

Abstract 14703: Sex Disparities in Management and Outcomes of Cardiac Arrest Complicating Acute Myocardial Infarction in the United States

Circulation ◽

10.1161/circ.142.suppl_3.14703 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Dhiran Verghese ◽

Sri Harsha Patlolla ◽

Saraschandra Vallabhajosyula

Keyword(s):

United States ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiac Arrest ◽

Hospital Mortality ◽

The United States ◽

Circulatory Support ◽

Multivariable Logistic Regression Analysis ◽

Shockable Rhythm ◽

Sex Disparities

Background: Sex disparities exist in acute cardiovascular care. Despite sex-specific cardiac arrest (CA) research being identified as a priority by professional societies, there are limited studies on this topic. Objectives: To assess sex disparities in management and outcomes of CA complicating acute myocardial infarction (AMI) in a contemporary United States population. Methods: Adult admissions with a primary diagnosis of AMI and concomitant diagnosis of CA were identified using the National Inpatient Sample. Outcomes of interest included sex disparities in in-hospital mortality, coronary angiography (CAG), percutaneous coronary intervention (PCI) and mechanical circulatory support (MCS) use. Results: Between January 1, 2000 and December 31, 2017, 11,622,528 admissions for AMI were identified, of which 584,216 (5.0%) were complicated by CA. Men had higher prevalence of CA compared to women (5.4% vs 4.4%, p< 0.001) in both STEMI and NSTEMI (2017 vs 2000, STEMI-men: 12.3% vs 7.8%, STEMI-women: 10.4% vs 7.5%, NSTEMI-men: 3.1% vs 2.7%, NSTEMI-women: 2.4% vs 2.5%). Women with AMI-CA were on average older (70.4 vs 65.0, p<0.001), of black race (12.6% vs 7.9%, p<0.001) and had higher comorbidity. Women were more likely to present with NSTEMI (36.4% vs 32.3%, p<0.001) and a non-shockable rhythm (47.6% vs 33.3%, p<0.001). Women less frequently received CAG (56.0% vs 66.2 %), early CAG (32.0% vs 40.2%), PCI (40.4% vs 49.7%), MCS (17.6% vs 22.0%), and CABG (all p<0.001). Women had significantly higher unadjusted in-hospital mortality (52.6% vs 40.6%, p < 0.001). In a multivariable logistic regression analysis, female sex was associated with higher in-hospital mortality (OR 1.13 [95% CI 1.11-1.14]; p< 0.001). When stratified by type of rhythm, type of AMI, presence of cardiogenic shock and location of CA, women consistently received less frequent CAG and experienced higher in-hospital mortality. Conclusion: In the largest 18-year study evaluating management and outcomes of CA in AMI, we identified the presence of significant sex disparities. Women with AMI-CA were older, with higher rates of non-shockable rhythm, were less likely to undergo therapeutic procedures including CAG, PCI, and MCS. Women had higher unadjusted and adjusted in-hospital mortality.

Download Full-text

Impact of Coronavirus Disease 2019 Pandemic on the Incidence and Management of Out‐of‐Hospital Cardiac Arrest in Patients Presenting With Acute Myocardial Infarction in England

Journal of the American Heart Association ◽

10.1161/jaha.120.018379 ◽

2020 ◽

Vol 9 (22) ◽

Author(s):

Muhammad Rashid (Hons) ◽

Chris P. Gale (Hons) ◽

Nick Curzen (Hons) ◽

Peter Ludman (Hons) ◽

Mark De Belder (Hons) ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiac Arrest ◽

Hospital Mortality ◽

Invasive Coronary Angiography ◽

Temporal Trends ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Hospital Cardiac Arrest

Background Studies have reported significant reduction in acute myocardial infarction–related hospitalizations during the coronavirus disease 2019 (COVID‐19) pandemic. However, whether these trends are associated with increased incidence of out‐of‐hospital cardiac arrest (OHCA) in this population is unknown. Methods and Results Acute myocardial infarction hospitalizations with OHCA during the COVID‐19 period (February 1–May 14, 2020) from the Myocardial Ischaemia National Audit Project and British Cardiovascular Intervention Society data sets were analyzed. Temporal trends were assessed using Poisson models with equivalent pre–COVID‐19 period (February 1–May 14, 2019) as reference. Acute myocardial infarction hospitalizations during COVID‐19 period were reduced by >50% (n=20 310 versus n=9325). OHCA was more prevalent during the COVID‐19 period compared with the pre–COVID‐19 period (5.6% versus 3.6%), with a 56% increase in the incidence of OHCA (incidence rate ratio, 1.56; 95% CI, 1.39–1.74). Patients experiencing OHCA during COVID‐19 period were likely to be older, likely to be women, likely to be of Asian ethnicity, and more likely to present with ST‐segment–elevation myocardial infarction. The overall rates of invasive coronary angiography (58.4% versus 71.6%; P <0.001) were significantly lower among the OHCA group during COVID‐19 period with increased time to reperfusion (mean, 2.1 versus 1.1 hours; P =0.05) in those with ST‐segment–elevation myocardial infarction. The adjusted in‐hospital mortality probability increased from 27.7% in February 2020 to 35.8% in May 2020 in the COVID‐19 group ( P <.001). Conclusions In this national cohort of hospitalized patients with acute myocardial infarction, we observed a significant increase in incidence of OHCA during COVID‐19 period paralleled with reduced access to guideline‐recommended care and increased in‐hospital mortality.

Download Full-text

Same-Day Versus Non-Simultaneous Extracorporeal Membrane Oxygenation Support for In-Hospital Cardiac Arrest Complicating Acute Myocardial Infarction

Journal of Clinical Medicine ◽

10.3390/jcm9082613 ◽

2020 ◽

Vol 9 (8) ◽

pp. 2613

Author(s):

Saraschandra Vallabhajosyula ◽

Sri Harsha Patlolla ◽

Malcolm R. Bell ◽

Wisit Cheungpasitporn ◽

John M. Stulak ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiac Arrest ◽

Extracorporeal Membrane Oxygenation ◽

Hospital Mortality ◽

Ecmo Support ◽

St Segment Elevation ◽

St Segment ◽

Hospitalization Costs ◽

Hospital Cardiac Arrest

Background: Although extracorporeal membrane oxygenation (ECMO) is used for hemodynamic support for in-hospital cardiac arrest (IHCA) complicating acute myocardial infarction (AMI), there are limited data on the outcomes stratified by the timing of initiation of this strategy. Methods: Adult (>18 years) AMI admissions with IHCA were identified using the National Inpatient Sample (2000–2017) and the timing of ECMO with relation to IHCA was identified. Same-day vs. non-simultaneous ECMO support for IHCA were compared. Outcomes of interest included in-hospital mortality, temporal trends, hospitalization costs, and length of stay. Results: Of the 11.6 million AMI admissions, IHCA was noted in 1.5% with 914 (<0.01%) receiving ECMO support. The cohort receiving same-day ECMO (N = 795) was on average female, with lower comorbidity, higher rates of ST-segment-elevation AMI, shockable rhythm, and higher rates of complications. Compared to non-simultaneous ECMO, the same-day ECMO cohort had higher rates of coronary angiography (67.5% vs. 51.3%; p = 0.001) and comparable rates of percutaneous coronary intervention (58.9% vs. 63.9%; p = 0.32). The same-day ECMO cohort had higher in-hospital mortality (63.1% vs. 44.5%; adjusted odds ratio 3.98 (95% confidence interval 2.34–6.77); p < 0.001), shorter length of stay, and lower hospitalization costs. Older age, minority race, non-ST-segment elevation AMI, multiorgan failure, and complications independently predicted higher in-hospital mortality in IHCA complicating AMI. Conclusions: Same-day ECMO support for IHCA was associated with higher in-hospital mortality compared to those receiving non-simultaneous ECMO support. Though ECMO-assisted CPR is being increasingly used, careful candidate selection is key to improving outcomes in this population.

Download Full-text