Key result
Pre-PCI sudden cardiac arrest in STEMI patients was associated with significantly higher in-hospital mortality (36.8% vs 8.8%, adjusted OR 2.33) compared to patients without sudden cardiac arrest.
Why the study?
Despite improvements in SCA management, survival remains poor in STEMI patients, prompting an evaluation of pre-PCI SCA incidence and related outcomes.
Does pre-PCI sudden cardiac arrest increase in-hospital mortality in patients admitted with STEMI?
Cohort (n=1,493)
No
Does pre-PCI sudden cardiac arrest increase in-hospital mortality in patients admitted with STEMI?
Odds Ratio: 2.33 (95% CI 1.05–5.14)
Absolute Event Rate: 36.8% vs 8.8%
p-value: p=0.03
Pre-PCI sudden cardiac arrest in STEMI patients is associated with significantly higher in-hospital mortality, especially when combined with cardiogenic shock, but 1-year mortality among survivors is similar to those without SCA.
Pre-PCI SCA was associated with higher in-hospital mortality in STEMI; leaves open whether targeted interventions improve outcomes in this subgroup.
Background: ST-segment elevation myocardial infarction (STEMI) is a frequent cause of sudden cardiac arrest (SCA) and early percutaneous coronary intervention (PCI) is associated with increased survival. Despite constant improvements in SCA management, survival remains poor. We aimed to assess pre-PCI SCA incidence and related outcomes in patients admitted with STEMI. Methods: This was a prospective cohort study of patients admitted with STEMI in a tertiary university hospital over 11 years. All patients were submitted to emergency coronary angiography. Baseline characteristics, details of the procedure, reperfusion strategies, and adverse outcomes were assessed. The primary outcome was in-hospital mortality. The secondary outcome was 1-year mortality after hospital discharge. Predictors of pre-PCI SCA was also assessed. Results: < 0.0001). In multivariate analysis, anterior MI, cardiogenic shock, age, pre-PCI SCA and lower ejection fraction remained significantly associated with in-hospital mortality. When we analyzed the interaction between pre-PCI SCA and cardiogenic shock upon admission there is a further increase in mortality risk when both conditions are present. For predictors of pre-PCI SCA, only younger age and cardiogenic shock remained significantly associated after multivariate analysis. Overall 1-year mortality rates were similar between pre-PCI SCA survivors and non-pre-PCI SCA group. Conclusion: In a cohort of consecutive patients admitted with STEMI, pre-PCI SCA was associated with higher in-hospital mortality, and its association with cardiogenic shock further increases mortality risk. However, long-term mortality among pre-PCI SCA survivors was similar to non-SCA patients. Understanding characteristics associated with pre-PCI SCA may help to prevent and improve the management of STEMI patients.
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Machado et al. (2023) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=1,493). Pre-PCI sudden cardiac arrest vs. No pre-PCI sudden cardiac arrest was evaluated on In-hospital mortality (OR 2.33, 95% CI 1.05-5.14, p=0.03). Pre-PCI sudden cardiac arrest in STEMI patients was associated with significantly higher in-hospital mortality (36.8% vs 8.8%, adjusted OR 2.33) compared to patients without sudden cardiac arrest.
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