Related Experiment Video
Updated: Aug 6, 2026
Establishing a Swine Model of Post-myocardial Infarction Heart Failure for Stem Cell Treatment
Published on: May 25, 2020
The IHCA paradox: high early mortality, yet comparable long-term survival in STEMI patients
Aneta Aleksova1,2, Alessandra Lucia Fluca3,4, Milijana Janjusevic3,4
1Department of Medical, Surgical and Health Sciences, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy. aaleksova@units.it.
Insights
In-hospital cardiac arrest in ST-elevation myocardial infarction (STEMI-IHCA) patients significantly increases short-term mortality risk. However, STEMI-IHCA survivors with rapid return of spontaneous circulation (ROSC) show comparable long-term survival to non-cardiac arrest STEMI patients.
Area of Science:
- Cardiology
- Critical Care Medicine
- Clinical Research
Background:
- In-hospital cardiac arrest (IHCA) in ST-elevation myocardial infarction (STEMI) patients presents a high mortality risk, with limited survival data.
- Understanding the clinical characteristics and outcomes of STEMI-IHCA is crucial for improving patient management.
Purpose of the Study:
- To compare the clinical features and outcomes of STEMI patients who experienced in-hospital cardiac arrest (STEMI-IHCA) versus those who did not (non-CA).
- To identify predictors of in-hospital mortality in STEMI-IHCA patients.
- To evaluate the long-term survival of STEMI-IHCA survivors compared to non-CA STEMI patients.
Main Methods:
- Retrospective analysis of 3311 STEMI patients treated in the Cath lab and transferred to the intensive cardiac care unit from 2003-2024.
- Comparison of clinical characteristics, in-hospital outcomes, and long-term mortality between STEMI-IHCA (n=208) and non-CA (n=3103) groups.
- Kaplan-Meier analysis for long-term survival assessment.
Main Results:
- STEMI-IHCA patients were older and had higher rates of peripheral artery disease, multivessel disease, and renal impairment compared to non-CA patients.
- Despite a high rate of shockable rhythm (72.7%) and rapid ROSC (<1 min) in STEMI-IHCA, in-hospital mortality was significantly higher (25.5% vs. 2.8%, p<0.01).
- In-hospital mortality predictors included IHCA, older age, peripheral artery disease, reduced LVEF, and higher TIMI risk index. Long-term mortality was similar between discharged STEMI-IHCA and non-CA survivors (36.8% vs. 33.3%, p=0.37).
Conclusions:
- STEMI-IHCA is associated with a substantially elevated in-hospital mortality risk.
- Prompt intervention and achieving rapid ROSC are critical for improving long-term outcomes in STEMI-IHCA patients.
- STEMI-IHCA survivors, especially those with rapid ROSC, can achieve long-term survival rates comparable to STEMI patients without cardiac arrest.
Abstract:
In-hospital cardiac arrest in STEMI (STEMI-IHCA) patients poses a formidable mortality risk, yet comprehensive survival data remain scarce. This study compared clinical characteristics and outcomes of STEMI-IHCA versus non-cardiac arrest (non-CA) patients. A cohort of 3311 STEMI patients, treated in the Cath lab and transferred to the intensive cardiac care unit, was retrospectively analyzed over a 21-year period (2003-2024). Of these, 208 (6.3%) had experienced STEMI-IHCA. The mean age was 66.2 ± 12.6 years; 77.8% were male. STEMI-IHCA patients more frequently had peripheral artery disease, multivessel disease, and renal impairment. In contrast, non-CA patients had higher rates of dyslipidemia and smoking. A striking 72.7% of STEMI-IHCA cases presented with a shockable rhythm, achieving rapid ROSC (< 1 min).Despite this, in-hospital mortality for STEMI-IHCA was drastically higher (25.5 vs. 2.8% for non-CA, p < 0.01), with most deaths occurring within three days (66 vs. 44.2%, p < 0.01). Predictors of in-hospital mortality were IHCA, older age, peripheral artery disease, reduced LVEF, and higher TIMI risk index. Among patients discharged alive, long-term mortality over a 96-month follow-up was similar between STEMI-IHCA and non-CA patients (36.8 vs. 33.3%, p = 0.37), confirmed by Kaplan-Meier analysis (p = 0.73) as well. Our findings confirm the high risk of in-hospital mortality risk associated with STEMI-IHCA. Nevertheless, among patients discharged alive, particularly with rapid ROSC, the long-term prognosis can align remarkably with that of STEMI patients who did not experience IHCA. This underscores the critical importance of prompt intervention as a powerful determinant of favorable long-term outcomes.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:24Kaplan-Meier Approach