Resuscitated cardiac arrest and prognosis following myocardial infarction
Albert E Alahmar1, Christopher P Nelson1, Kym I E Snell1
1Department of Cardiovascular Sciences, University of Leicester, and Leicester NIHR Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK.
Insights
Cardiac arrest (CA) in ST-elevation myocardial infarction (STEMI) patients increases early mortality risk. However, resuscitated CA does not impact long-term survival for STEMI patients who are discharged.
Area of Science:
- Cardiology
- Critical Care Medicine
- Public Health
Background:
- Resuscitated cardiac arrest (CA) complicating ST-elevation myocardial infarction (STEMI) is linked to higher inpatient mortality.
- The long-term prognostic implications of CA in STEMI patients remain unclear.
Purpose of the Study:
- To investigate the impact of resuscitated CA on outcomes in ST-elevation myocardial infarction (STEMI) patients.
- To specifically assess the effect on patients who survive to hospital discharge.
Main Methods:
- Analysis of UK Myocardial Ischaemia National Audit Project data (January 2008-March 2010).
- Survival analyses were employed to evaluate the independent effect of resuscitated CA on mortality.
- In-hospital, 30-day, 1-year, and medium-term all-cause mortality were assessed.
Main Results:
- 10.9% of 48,749 STEMI patients experienced resuscitated CA.
- Resuscitated CA significantly increased in-hospital mortality risk (HR 4.05).
- For discharge survivors, resuscitated CA raised 30-day mortality risk (HR 1.53) but not longer-term mortality (1-year HR 0.95).
Conclusions:
- STEMI patients with resuscitated CA require vigilant early post-event monitoring.
- Resuscitated CA does not adversely affect the long-term prognosis of STEMI patients in contemporary practice.
Objectives:
To determine whether resuscitated cardiac arrest (CA) complicating ST elevation myocardial infarction (STEMI) impacts outcome, particularly in patients surviving to discharge.
Background:
Resuscitated CA complicating STEMI is associated with increased inpatient mortality. The impact on later prognosis is unclear.
Methods:
We analysed data from the UK Myocardial Ischaemia National Audit Project for STEMI patients admitted during January 2008-March 2010. We used survival analyses to assess the independent impact of resuscitated CA during the index episode on inhospital, 30 days, 1 year and medium term all-cause mortality.
Results:
Of 48 749 STEMI patients, 5308 (10.9%) were recorded as having a CA. Of these, 1557 (29.3%) died on the day of CA. In survivors, after covariate adjustment, resuscitated CA was associated with increased risk of death during the index admission (HR 4.05 (3.69 to 4.45) p<0.001). In patients surviving to discharge, a history of resuscitated CA was associated with increased risk of death to 30 days (HR 1.53 (1.18 to 2.00), p<0.001). However, beyond 30 days, resuscitated CA was not associated with increased mortality risk (1-year HR 0.95 (0.79 to 1.14, p=0.596); 3.5 years HR 0.90 (0.78 to 1.04), p=0.144). The influence of resuscitated CA on inhospital or 30-day mortality was similar whether CA occurred before or after hospital admission. Where the resuscitated CA rhythm was asystole, inhospital mortality was higher compared with ventricular arrhythmia (p<0.001) or pulseless electrical activity (p=0.011). Late resuscitated CA (occurring after the day of index STEMI) was associated with higher 30-day postdischarge mortality compared with early resuscitated CA (p=0.023).
Conclusions:
STEMI complicated by resuscitated CA merits careful monitoring in the early period postevent. In contemporary practice, there is no impact of resuscitated CA on longer-term prognosis.
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