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Prognostic implications and outcomes of cardiac arrest among contemporary patients with STEMI treated with PCI
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)...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8319445/ https://www.ncbi.nlm.nih.gov/pubmed/34345872 http://dx.doi.org/10.1016/j.resplu.2021.100149 |
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author | Kumar, Anirudh Zhou, Leon Huded, Chetan P. Moennich, Laurie Ann Menon, Venu Puri, Rishi Reed, Grant W. Nair, Ravi Khatri, Jaikirshan J. Krishnaswamy, Amar Lincoff, A. Michael Ellis, Stephen G. Ziada, Khaled M. Kapadia, Samir R. Khot, Umesh N. |
author_facet | Kumar, Anirudh Zhou, Leon Huded, Chetan P. Moennich, Laurie Ann Menon, Venu Puri, Rishi Reed, Grant W. Nair, Ravi Khatri, Jaikirshan J. Krishnaswamy, Amar Lincoff, A. Michael Ellis, Stephen G. Ziada, Khaled M. Kapadia, Samir R. Khot, Umesh N. |
author_sort | Kumar, Anirudh |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-8319445 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-83194452021-08-02 Prognostic implications and outcomes of cardiac arrest among contemporary patients with STEMI treated with PCI Kumar, Anirudh Zhou, Leon Huded, Chetan P. Moennich, Laurie Ann Menon, Venu Puri, Rishi Reed, Grant W. Nair, Ravi Khatri, Jaikirshan J. Krishnaswamy, Amar Lincoff, A. Michael Ellis, Stephen G. Ziada, Khaled M. Kapadia, Samir R. Khot, Umesh N. Resusc Plus Clinical Paper 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. Elsevier 2021-07-15 /pmc/articles/PMC8319445/ /pubmed/34345872 http://dx.doi.org/10.1016/j.resplu.2021.100149 Text en © 2021 Published by Elsevier B.V. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Clinical Paper Kumar, Anirudh Zhou, Leon Huded, Chetan P. Moennich, Laurie Ann Menon, Venu Puri, Rishi Reed, Grant W. Nair, Ravi Khatri, Jaikirshan J. Krishnaswamy, Amar Lincoff, A. Michael Ellis, Stephen G. Ziada, Khaled M. Kapadia, Samir R. Khot, Umesh N. Prognostic implications and outcomes of cardiac arrest among contemporary patients with STEMI treated with PCI |
title | Prognostic implications and outcomes of cardiac arrest among contemporary patients with STEMI treated with PCI |
title_full | Prognostic implications and outcomes of cardiac arrest among contemporary patients with STEMI treated with PCI |
title_fullStr | Prognostic implications and outcomes of cardiac arrest among contemporary patients with STEMI treated with PCI |
title_full_unstemmed | Prognostic implications and outcomes of cardiac arrest among contemporary patients with STEMI treated with PCI |
title_short | Prognostic implications and outcomes of cardiac arrest among contemporary patients with STEMI treated with PCI |
title_sort | prognostic implications and outcomes of cardiac arrest among contemporary patients with stemi treated with pci |
topic | Clinical Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8319445/ https://www.ncbi.nlm.nih.gov/pubmed/34345872 http://dx.doi.org/10.1016/j.resplu.2021.100149 |
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