Key result
Cardiac arrest complicating STEMI did not portend any additional long-term mortality risk among hospital survivors (HR 1.01) despite being associated with significantly higher 30-day mortality.
Why the study?
Cardiac arrest complicating STEMI is associated with higher mortality, but contemporary presentation, management, and outcomes in the primary PCI era needed description.
Does cardiac arrest complicating STEMI increase short-term and long-term mortality in patients undergoing primary PCI?
Observational (n=1,272)
No
Does cardiac arrest complicating STEMI increase short-term and long-term mortality in patients undergoing primary PCI?
Hazard Ratio: 1.01 (95% CI 0.56–1.82)
p-value: p=0.97
Cardiac arrest complicating STEMI is associated with high early mortality, but patients who survive to hospital discharge have long-term survival comparable to those without cardiac arrest.
CA-STEMI patients require prioritized rapid reperfusion and shock protocols; extends contemporary PCI-era outcome data for this high-risk subgroup.
BACKGROUND: Cardiac arrest (CA) complicating ST-elevation myocardial infarction (STEMI) is associated with a disproportionately higher risk of mortality. We described the contemporary presentation, management, and outcomes of CA patients in the era of primary percutaneous coronary intervention (PCI). METHODS: We reviewed 1,272 consecutive STEMI patients who underwent PCI between 1/1/2011-12/31/2016 and compared characteristics and outcomes between non-CA (N = 1,124) and CA patients (N = 148), defined per NCDR definitions as pulseless arrest requiring cardiopulmonary resuscitation and/or defibrillation within 24-hr of PCI. RESULTS: Male gender, cerebrovascular disease, chronic kidney disease, in-hospital STEMI, left main or left anterior descending culprit vessel, and initial TIMI 0 or 1 flow were independent predictors for CA. CA patients had longer door-to-balloon-time (106 [83,139] vs. 97 [74,121] minutes, p = 0.003) and greater incidence of cardiogenic shock (48.0% vs. 5.9%, p < 0.001), major bleeding (25.0% vs. 9.4%, p < 0.001), and 30-day mortality (16.2% vs. 4.1%, p < 0.001). Risk score for 30-day mortality based on presenting characteristics provided excellent prognostic accuracy (area under the curve = 0.902). However, over long-term follow-up of 4.5 ± 2.4 years among hospital survivors, CA did not portend any additional mortality risk (HR: 1.01, 95% CI: 0.56-1.82, p = 0.97). CONCLUSIONS: In a contemporary cohort of STEMI patients undergoing primary PCI, CA occurs in >10% of patients and is an important mechanism of mortality in patients with in-hospital STEMI. While CA is associated with adverse outcomes, it carries no additional risk of long-term mortality among survivors highlighting the need for strategies to improve the in-hospital care of STEMI patients with CA.
No takes yet. Share an insight, caveat, or question.
Kumar et al. (2021) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=1,272). Cardiac arrest vs. No cardiac arrest was evaluated on Long-term mortality among hospital survivors (HR 1.01, 95% CI 0.56-1.82, p=0.97). Cardiac arrest complicating STEMI did not portend any additional long-term mortality risk among hospital survivors (HR 1.01) despite being associated with significantly higher 30-day mortality.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: