Pre-percutaneous coronary intervention sudden cardiac arrest in ST-elevation myocardial infarction: Incidence,
Guilherme Pinheiro Machado1,2, Andre Luiz Theobald1,2, Gustavo Neves de Araujo3,4
1Postgraduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Insights
Sudden cardiac arrest (SCA) before percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) patients significantly increases in-hospital mortality. However, long-term survival for SCA survivors is comparable to those without SCA.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Research
Background:
- ST-segment elevation myocardial infarction (STEMI) is a primary cause of sudden cardiac arrest (SCA).
- Early percutaneous coronary intervention (PCI) improves survival in STEMI patients.
- Despite advancements, SCA management outcomes remain suboptimal.
Purpose of the Study:
- To determine the incidence of pre-PCI SCA in STEMI admissions.
- To evaluate the outcomes associated with pre-PCI SCA.
- To identify predictors of pre-PCI SCA in STEMI patients.
Main Methods:
- Prospective cohort study over 11 years including 1,493 STEMI patients.
- All patients underwent emergency coronary angiography.
- Assessment of baseline characteristics, procedural details, reperfusion strategies, and adverse outcomes, including in-hospital and 1-year mortality.
Main Results:
- Pre-PCI SCA occurred in 8.9% of STEMI patients (133/1,493).
- In-hospital mortality was significantly higher in the pre-PCI SCA group (36.8% vs. 8.8%).
- Anterior MI, cardiogenic shock, older age, and lower ejection fraction predicted in-hospital mortality; younger age and cardiogenic shock predicted pre-PCI SCA. The combination of pre-PCI SCA and cardiogenic shock amplified mortality risk.
Conclusions:
- Pre-PCI SCA is linked to increased in-hospital mortality in STEMI patients, particularly when combined with cardiogenic shock.
- Long-term mortality for STEMI patients who survive pre-PCI SCA is similar to those who do not experience SCA.
- Identifying characteristics of patients at risk for pre-PCI SCA is crucial for improving STEMI management and prevention strategies.
Background:
ST-segment elevation myocardial infarction (STEMI) is a frequent cause of sudden cardiac arrest (SCA) and early percutaneous coronary intervention (PCI) is associated with increased survival. Despite constant improvements in SCA management, survival remains poor. We aimed to assess pre-PCI SCA incidence and related outcomes in patients admitted with STEMI.
Methods:
This was a prospective cohort study of patients admitted with STEMI in a tertiary university hospital over 11 years. All patients were submitted to emergency coronary angiography. Baseline characteristics, details of the procedure, reperfusion strategies, and adverse outcomes were assessed. The primary outcome was in-hospital mortality. The secondary outcome was 1-year mortality after hospital discharge. Predictors of pre-PCI SCA was also assessed.
Results:
During the study period 1,493 patients were included; the mean age was 61.1 years (±12), and 65.3% were male. Pre-PCI SCA was present in 133 (8.9%) patients. In-hospital mortality was higher in the pre-PCI SCA group (36.8% vs. 8.8%, p < 0.0001). In multivariate analysis, anterior MI, cardiogenic shock, age, pre-PCI SCA and lower ejection fraction remained significantly associated with in-hospital mortality. When we analyzed the interaction between pre-PCI SCA and cardiogenic shock upon admission there is a further increase in mortality risk when both conditions are present. For predictors of pre-PCI SCA, only younger age and cardiogenic shock remained significantly associated after multivariate analysis. Overall 1-year mortality rates were similar between pre-PCI SCA survivors and non-pre-PCI SCA group.
Conclusion:
In a cohort of consecutive patients admitted with STEMI, pre-PCI SCA was associated with higher in-hospital mortality, and its association with cardiogenic shock further increases mortality risk. However, long-term mortality among pre-PCI SCA survivors was similar to non-SCA patients. Understanding characteristics associated with pre-PCI SCA may help to prevent and improve the management of STEMI patients.
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