In-Hospital cardiac arrest complicating ST-elevation myocardial Infarction: Temporal trends and outcomes based on
Anusha G Bhat1, Dhiran Verghese2, Sri Harsha Patlolla3
1Division of Cardiovascular Medicine, Department of Medicine, University of Maryland, Baltimore, MD, USA.
Insights
Early percutaneous coronary intervention (PCI) for ST-segment-elevation myocardial infarction (STEMI) significantly reduces in-hospital cardiac arrest (IHCA) and mortality. This strategy impacts IHCA timing and type, offering better outcomes than delayed PCI or medical management alone.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Limited data exist on the relationship between ST-segment-elevation myocardial infarction (STEMI) management strategies and in-hospital cardiac arrest (IHCA).
- Understanding these associations is crucial for optimizing patient care and outcomes in STEMI cases complicated by IHCA.
Purpose of the Study:
- To investigate the incidence, trends, and outcomes of IHCA in patients with STEMI.
- To compare IHCA outcomes based on different management strategies: early percutaneous coronary intervention (PCI), delayed PCI, and medical management.
Main Methods:
- Analysis of adult STEMI patients with IHCA from the National Inpatient Sample (2000-2017).
- Stratification into early PCI (day 0), delayed PCI (≥ day 1), or medical management (no PCI) groups; coronary artery bypass surgery was excluded.
- Outcomes assessed included in-hospital mortality, adverse events, length of stay, and hospitalization costs.
Main Results:
- IHCA occurred in 2.6% of STEMI admissions, with increasing incidence over the study period.
- Medical management had higher IHCA rates (3.6%) compared to early (2.0%) and delayed PCI (1.3%).
- Revascularization (early or delayed PCI) was associated with significantly lower IHCA rates and in-hospital mortality compared to medical management. Early PCI showed 49% mortality versus 82.5% for medical management.
Conclusions:
- Early percutaneous coronary intervention (PCI) in STEMI significantly influences the natural history of in-hospital cardiac arrest (IHCA).
- Early PCI is associated with reduced IHCA incidence and improved survival rates in STEMI patients.
- Management strategy, particularly early revascularization, plays a critical role in the outcomes of STEMI patients experiencing IHCA.
Background:
There are limited data on the relationship of ST-segment-elevation myocardial infarction (STEMI) management strategy and in-hospital cardiac arrest (IHCA).
Aims:
To investigate the trends and outcomes of IHCA in STEMI by management strategy.
Methods:
Adult with STEMI complicated by IHCA from the National Inpatient Sample (2000-2017) were stratified into early percutaneous coronary intervention (PCI) (day 0 of hospitalization), delayed PCI (PCI ≥ day 1), or medical management (no PCI). Coronary artery bypass surgery was excluded. Outcomes of interest included in-hospital mortality, adverse events, length of stay, and hospitalization costs.
Results:
Of 3,967,711 STEMI admissions, IHCA was noted in 102,424 (2.6%) with an increase in incidence during this study period. Medically managed STEMI had higher rates of IHCA (3.6% vs 2.0% vs 1.3%, p < 0.001) compared to early and delayed PCI, respectively. Revascularization was associated with lower rates of IHCA (early PCI: adjusted odds ratio [aOR] 0.44 [95% confidence interval (CI) 0.43-0.44], p < 0.001; delayed PCI aOR 0.33 [95% CI 0.32-0.33], p < 0.001) compared to medical management. Non-revascularized patients had higher rates of non-shockable rhythms (62% vs 35% and 42.6%), but lower rates of multiorgan damage (44% vs 52.7% and 55.6%), cardiogenic shock (28% vs 65% and 57.4%) compared to early and delayed PCI, respectively (all p < 0.001). In-hospital mortality was lower with early PCI (49%, aOR 0.18, 95% CI 0.17-0.18), and delayed PCI (50.9%, aOR 0.18, 95% CI 0.17-0.19) (p < 0.001) compared to medical management (82.5%).
Conclusion:
Early PCI in STEMI impacts the natural history of IHCA including timing and type of IHCA.
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