Background:
ST-elevation myocardial infarction (STEMI) is a potentially fatal condition that may be complicated by cardiac arrest (CA). However, the impact of CA complicating STEMI on prognosis in the contemporary era of rapid primary PCI is uncertain.
Methods:
We reviewed consecutive cases of STEMI treated with percutaneous coronary intervention (PCI) at our center between January 1, 2011 and December 31, 2016. Baseline clinical characteristics and in-hospital long-term outcomes were compared between patients with and without CA.
Results:
Among 1,272 patients with STEMI, 148 (11.6%) had CA (30.4% out-of-hospital, 69.6% after ED arrival). Compared to patients without CA, patients with STEMI+CA were more likely to have a history of heart failure, valve surgery, peripheral and cerebrovascular disease, and chronic kidney disease with a trend towards increased prevalence of left main or left anterior descending culprit vessel. Patients with STEMI+CA had greater creatinine (1.28±0.92 vs. 1.07±0.67, p=0.013, infarct size (CK-MB 171.6±131.6 vs. 139.2±117.0 ng/mL, p=0.010; troponin T 6.2±6.2 vs. 5.0±4.8 ng/mL, p=0.024), door-to-balloon-time (118.1±63.6 vs. 106.8±64.0, p=0.045), and incidence of cardiogenic shock (48.0% vs. 5.9%, p<0.0001) and intra-aortic balloon pump need (36.5% vs. 8.3%, p<0.0001). Patients with STEMI+ CA had higher rates of major bleeding (25.0% vs. 9.4%, p<0.0001) and post-PCI heart failure (13.5% vs. 8.1%, p=0.042). Patients with STEMI+CA had significantly greater mortality in-hospital (14.9% vs. 3.6%, p<0.0001) and at 1-year (22.9% vs. 9.3%, p<0.0001) (Figure).
Conclusions:
CA is a complication in >1 in 10 patients with STEMI and is associated with significantly higher morbidity and mortality compared with STEMI without CA. Strategies to improve the care and outcomes of STEMI patients with CA are needed.
P2745The prognostic impact of infarction-size on the development of cardiac arrest in premature acute myocardial infection
