Key result
OHCA in STEMI linked to ~11-fold higher in-hospital mortality.
Why the study?
The clinical characteristics and prognostic outcomes of STEMI patients who experience out-of-hospital cardiac arrest remain poorly understood in Asian populations.
Does out-of-hospital cardiac arrest increase the risk of in-hospital cardiac arrest and mortality in patients presenting with STEMI?
Cohort (n=70,901)
Yes
Does out-of-hospital cardiac arrest increase the risk of in-hospital cardiac arrest and mortality in patients presenting with STEMI?
Absolute Event Rate: 20.2% vs 1.8%
p-value: p=<0.001
In a nationwide Asian registry, OHCA complicated 1.9% of STEMI cases but was highly fatal, with subsequent in-hospital cardiac arrest identified as the strongest predictor of in-hospital mortality (HR 8.88).
OHCA in STEMI signals high subsequent IHCA risk and mortality; observational data leaves open whether targeted prevention improves survival.
Objectives: Out-of-hospital cardiac arrest (OHCA) is a major cause of mortality in patients with ST-segment elevation myocardial infarction (STEMI). However, the clinical characteristics and prognostic outcomes of STEMI patients who experience OHCA remain poorly understood. Methods: Using data from the CCC-ACS (Improving Care for Cardiovascular Disease in China - Acute Coronary Syndrome) project, we analyzed data from 70,901 patients with STEMI. Multivariable regression models were used to evaluate the associations between patient characteristics and the occurrence of OHCA as well as subsequent in-hospital cardiac arrest (IHCA). Results: Among the 70,901 STEMI patients included in this national retrospective cohort study, 1.9 % experienced OHCA, of whom 35.1 % subsequently developed IHCA. Ten independent predictors of OHCA were identified, including a history of atrial fibrillation, chronic heart failure, chronic renal failure, diabetes mellitus, ischemic stroke, culprit lesions in the left main coronary artery (LMCA), left circumflex artery (LCX), or right coronary artery (RCA), and the use of antiplatelet agents or angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB). IHCA was the strongest predictor of in-hospital mortality among OHCA patients, with four factors independently associated with IHCA: advanced age, female gender, Killip class IV, and absence of standard modifiable cardiovascular risk factors (SMuRF-less). Percutaneous coronary intervention (PCI) and timely medical treatment (statins, ACEI/ARB, and mineralocorticoid receptor antagonists [MRA]) are critical for preventing IHCA. Conclusions: OHCA is a rare but highly fatal complication in STEMI patients. A multitude of factors are associated with OHCA and subsequent IHCA, laying the groundwork for early risk stratification and optimized treatment strategies to enhance patient outcomes.
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Pang et al. (2025) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=70,901). Out-of-hospital cardiac arrest (OHCA) vs. No OHCA was evaluated on In-hospital mortality (p=<0.001). Out-of-hospital cardiac arrest occurred in 1.9% of STEMI patients and was associated with a significantly higher in-hospital mortality rate (20.2%) compared to those without OHCA (1.8%), with subsequent in-hospital cardiac arrest being the strongest independent predictor of death (HR 8.88).
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