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Prognostic implications and outcomes of cardiac arrest among contemporary patients with STEMI treated with PCI
- Source :
- Resuscitation Plus, Vol 7, Iss, Pp 100149-(2021), Resuscitation Plus
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- 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.
- Subjects :
- medicine.medical_specialty
medicine.medical_treatment
Specialties of internal medicine
Outcomes
Culprit
Internal medicine
medicine
Risk of mortality
cardiovascular diseases
Cardiopulmonary resuscitation
Myocardial infarction
Earth-Surface Processes
PCI, percutaneous coronary intervention
business.industry
Cardiogenic shock
Percutaneous coronary intervention
Cardiac arrest
medicine.disease
ACC NCDR, American College of Cardiology National Cardiovascular Data Registry
STEMI, ST-elevation myocardial infarction
ST-elevation myocardial infarction
surgical procedures, operative
RC581-951
CA, cardiac arrest
Conventional PCI
Clinical Paper
Cardiology
business
TIMI
Subjects
Details
- ISSN :
- 26665204
- Volume :
- 7
- Database :
- OpenAIRE
- Journal :
- Resuscitation Plus
- Accession number :
- edsair.doi.dedup.....bc01aa431b1e3e0c795eaee8085272ed
- Full Text :
- https://doi.org/10.1016/j.resplu.2021.100149