• Resuscitation · May 2023

    In-Hospital Cardiac Arrest Complicating ST-Elevation Myocardial Infarction: Temporal Trends and Outcomes Based on Management Strategy.

    • Anusha G Bhat, Dhiran Verghese, Harsha PatlollaSriSDepartment of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA., Alexander G Truesdell, Wayne B Batchelor, Timothy D Henry, Robert J Cubeddu, Matthew Budoff, Quang Bui, Matthew BelfordPeterPSection of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA., X ZhaoDavidDSection of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA., and Saraschandra Vallabhajosyula.
    • Division of Cardiovascular Medicine, Department of Medicine, University of Maryland, Baltimore, MD, USA.
    • Resuscitation. 2023 May 1; 186: 109747109747.

    BackgroundThere are limited data on the relationship of ST-segment-elevation myocardial infarction (STEMI) management strategy and in-hospital cardiac arrest (IHCA).AimsTo investigate the trends and outcomes of IHCA in STEMI by management strategy.MethodsAdult 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.ResultsOf 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%).ConclusionEarly PCI in STEMI impacts the natural history of IHCA including timing and type of IHCA.Copyright © 2023 Elsevier B.V. All rights reserved.

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