Key result
Pre-hospital cardiac arrest occurs in ~1% of ACS patients and links to higher in-hospital mortality.
Why the study?
Cardiac arrest in acute coronary syndromes is associated with high morbidity and mortality, but contemporary management patterns and outcomes of ACS patients with pre-hospital cardiac arrest were not well characterized.
Does pre-hospital cardiac arrest in patients with acute coronary syndromes impact in-hospital outcomes and the utilization of evidence-based therapies?
Observational (n=14,010)
Yes
Does pre-hospital cardiac arrest in patients with acute coronary syndromes impact in-hospital outcomes and the utilization of evidence-based therapies?
ACS patients with pre-hospital cardiac arrest suffer higher in-hospital mortality and complications, which may be compounded by the observed underutilization of early evidence-based medical therapies.
Answers are grounded in this paper and cite their sources.
Heightens in-hospital vigilance for ACS with pre-hospital arrest; extends risk data but leaves therapy optimization and causality open.
OBJECTIVES: Cardiac arrest in acute coronary syndromes (ACS) is associated with high morbidity and mortality. We examined the clinical characteristics, contemporary management patterns and outcomes of ACS patients with pre-hospital cardiac arrest. METHODS: The Global Registry of Acute Coronary Events and the Canadian Registry of Acute Coronary Events enrolled 14,010 ACS patients in 1999-2008. We compared the clinical characteristics, in-hospital treatment and outcomes between patients with and without pre-hospital cardiac arrest. RESULTS: Overall, 206 (1.4%) patients had cardiac arrest prior to hospital presentation. ACS patients with pre-hospital cardiac arrest were less frequently treated with aspirin, β-blocker, angiotensin-converting enzyme inhibitors, and statins within the first 24 h of presentation, but the use of cardiac procedures was similar compared to the group without cardiac arrest. Patients with pre-hospital cardiac arrest had significantly higher rates of in-hospital adverse events. Factors independently associated with pre-hospital cardiac arrest included male gender, current smoker status, tachycardia, higher Killip class and ST-segment deviation. CONCLUSION: ACS patients with pre-hospital cardiac arrest continue to have more in-hospital complications and higher mortality. Their use of evidence-based medical therapies was lower but the use of cardiac procedures was similar compared to the group without cardiac arrest. Better utilization of evidence-based therapies in these patients may translate into improved outcomes.
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Li et al. (2013) conducted an observational in Acute coronary syndromes (n=14,010). Pre-hospital cardiac arrest vs. No pre-hospital cardiac arrest was evaluated on In-hospital adverse events. Pre-hospital cardiac arrest occurred in 1.4% of ACS patients and was associated with significantly higher rates of in-hospital adverse events and mortality.
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