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Early vs. delayed in-hospital cardiac arrest complicating ST-elevation myocardial infarction receiving primary

Saraschandra Vallabhajosyula1, Saarwaani Vallabhajosyula2, Malcolm R Bell2

  • 1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, United States; Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, United States.

Resuscitation
|November 24, 2019
PubMed

Insights

Delayed in-hospital cardiac arrest (IHCA) in ST-elevation myocardial infarction (STEMI) patients receiving primary percutaneous coronary intervention (pPCI) is linked to worse outcomes. This includes higher mortality and increased resource utilization compared to early IHCA.

Area of Science:

  • Cardiology
  • Critical Care Medicine
  • Health Services Research

Background:

  • Limited data exists on in-hospital cardiac arrest (IHCA) timing and outcomes in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI).
  • Understanding IHCA timing is crucial for optimizing patient care and resource allocation in STEMI management.

Purpose of the Study:

  • To investigate the in-hospital mortality, temporal trends, and resource utilization associated with early versus delayed IHCA in STEMI patients receiving pPCI.
  • To compare outcomes between patients experiencing IHCA on hospital day zero (early) versus on or after hospital day one (delayed).

Main Methods:

  • A retrospective cohort study utilized the National Inpatient Sample database from 2000-2014.
  • Included STEMI admissions receiving pPCI on hospital day zero; excluded transfers, DNR status, missing IHCA timing, and surgical revascularization.
  • IHCA was categorized as early (day zero) or delayed (day 1+); primary outcome was in-hospital mortality, with secondary outcomes including trends and resource use.

Main Results:

  • Of 19,185 STEMI admissions, 80% had early IHCA.
  • The delayed IHCA cohort was older, more likely female, had higher comorbidities, non-shockable rhythms, and acute organ failure.
  • Early IHCA rates increased (aOR 1.67), while delayed IHCA rates decreased (aOR 0.60) from 2000 to 2014.
  • Delayed IHCA was associated with significantly higher in-hospital mortality (aOR 5.35), increased hospitalization costs, and lower home discharge rates compared to early IHCA.

Conclusions:

  • Delayed IHCA in STEMI patients receiving pPCI is associated with substantially higher in-hospital mortality.
  • Patients experiencing delayed IHCA also demonstrate greater resource utilization and poorer discharge destinations.
  • These findings highlight the critical impact of IHCA timing on patient outcomes and healthcare resource allocation in STEMI management.
Abstract

Keywords:
Critical care cardiologyIn-hospital cardiac arrestNational Inpatient SampleOutcomes researchST-elevation myocardial infarction

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