Risk factors for sudden cardiac arrest in patients with ST-segment elevation myocardial infarction: a retrospective
Chang-Hung Chu1,2, Hong-Mo Shih1,2,3, Shao-Hua Yu2,4
1School of Medicine, College of Medicine, China Medical University, No. 91, Xueshi Rd., Taichung, 404, Taiwan.
Insights
Sudden cardiac arrest (SCA) in ST-segment elevation myocardial infarction (STEMI) patients is linked to left main coronary artery disease (CAD), lower estimated glomerular filtration rate (eGFR), and younger age. These factors predict SCA risk before catheterization.
Area of Science:
- Cardiology
- Internal Medicine
- Critical Care Medicine
Background:
- Sudden cardiac arrest (SCA) is a severe complication of acute myocardial infarction (MI), particularly ST-segment elevation myocardial infarction (STEMI).
- Identifying pre-catheterization risk factors for SCA in STEMI patients is crucial for timely intervention.
- This study focuses on risk stratification in STEMI patients presenting with or at high risk of SCA.
Purpose of the Study:
- To identify pre-catheterization risk factors for SCA in patients diagnosed with STEMI.
- To analyze demographic, clinical, and angiographic data to predict SCA occurrence.
- To inform early risk assessment and management strategies for STEMI patients.
Main Methods:
- Retrospective analysis of STEMI patients with confirmed coronary artery disease (CAD) from a tertiary care center (2016-2019).
- Data collection included demographics, medical history, estimated glomerular filtration rate (eGFR), and coronary angiographic findings.
- Bivariate and multivariate logistic regression analyses were employed to determine significant risk factors for SCA.
Main Results:
- Left main CAD (OR: 3.77), lower eGFR (OR: 0.97), and younger age (OR: 0.98) were identified as significant risk factors for SCA in STEMI patients.
- Patients with SCA were generally younger, had a higher prevalence of diabetes mellitus, and lower eGFR compared to those without SCA.
- Higher prevalence of left main CAD and three-vessel disease was observed in STEMI patients who experienced SCA.
Conclusions:
- Left main CAD, reduced eGFR, and younger age are key predictors of SCA in STEMI patients.
- These findings highlight the importance of early risk assessment based on these factors.
- Targeted interventions for patients with these risk factors may reduce SCA incidence post-STEMI.
Background:
Sudden cardiac arrest (SCA) is a critical complication of acute myocardial infarction, especially ST-segment elevation myocardial infarction (STEMI). This study identified the risk factors for SCA in patients with STEMI before receiving catheterization.
Methods:
We retrospectively analyzed the data of patients with STEMI and cardiac arrest who presented to a tertiary care center in Taiwan between January 1, 2016, and December 31, 2019. Only patients with coronary artery disease (CAD) confirmed by coronary angiography were included in this study. We collected the patients' demographic and clinical data, such as age, sex, medical history, estimated glomerular filtration rate (eGFR), and coronary angiographic findings. The primary outcome of this study was SCA in patients with STEMI. Continuous and nominal variables were compared using the two-sample Student's t-test and chi-squared test, respectively. The results of logistic regression were subjected to multivariate analysis with adjustment for possible confounders.
Results:
A total of 920 patients with STEMI and coronary angiography-documented CAD and 108 patients with SCA who presented between January 1, 2016, and December 31, 2019, were included. The bivariate logistic regression analysis of patients' demographic data revealed that patients with STEMI and SCA were slightly younger, were more likely to have diabetes mellitus, and had a lower eGFR than did the patients without SCA. The coronary angiographic findings indicated a higher prevalence of left main CAD and three-vessel disease in patients with SCA than in patients without SCA. Multivariate logistic regression revealed that left main CAD (odds ratio [OR]: 3.77; 95% confidence interval [CI], 1.84 to 7.72), a lower eGFR (OR: 0.97; 95% CI, 0.96 to 0.98), and younger age (OR: 0.98; 95% CI, 0.96 to 0.99) were the risk factors for SCA in patients with STEMI.
Conclusions:
Left main CAD, lower eGFR, and younger age are the risk factors for cardiac arrest in patients with acute myocardial infarction.
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