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INFLUENCE OF CARDIAC ARREST AND CARDIOGENIC SHOCK ON OUTCOMES AMONG 4,500 CONSECUTIVE ST ELEVATION MYOCARDIAL INFARCTION PATIENTS
192 JACC March 21, 2017 Volume 69, Issue 11
Acute and Stable Ischemic Heart Disease INFLUENCE OF CARDIAC ARREST AND CARDIOGENIC SHOCK ON OUTCOMES AMONG 4,500 CONSECUTIVE ST ELEVATION MYOCARDIAL INFARCTION PATIENTS Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m. Session Title: Cardiac Arrest, Diabetes, and Other High Risk Features of Patients With Acute Coronary Syndrome Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical Presentation Number: 1204-346 Authors: Claire Donovan, Benjamin Johnson, Ross Garberich, John Hibbs, David Larson, Timothy Henry, Scott Sharkey, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA Background: The influence of cardiac arrest and cardiogenic shock on outcomes of patients with ST-elevation myocardial infarction (STEMI) in the percutaneous coronary intervention (PCI) era is incompletely studied.
Methods: We examined a regional STEMI network to determine incidence, characteristics and outcomes of STEMI complicated by cardiac arrest with and without cardiogenic shock. Cardiac arrest was classified as shockable (ventricular tachycardia/ventricular fibrillation) or nonshockable (asystole/pulseless electrical activity). Results: From March 2003 – December 2014, we enrolled 4,511 consecutive patients including 499 (11%) with cardiac arrest prior to PCI. The cardiac arrest was shockable in 441 (88%) patients and non-shockable in 58 (12%) patients.
Conclusions: In this contemporary STEMI population, most with cardiac arrest had no history of myocardial infarction or revascularization. Cardiogenic shock influenced hospital mortality only in those with shockable rhythm. A non-proximal coronary culprit was present in onethird of patients with shockable and non-shockable cardiac arrest and culprit coronary anatomy was no different in those with and without cardiogenic shock. Nearly 75% of patients with shockable arrest survived to discharge, 95% of whom were alive at 1 year. In contrast, only 40% of patients with non-shockable arrest survived to discharge, 92% of whom were alive at 1 year.
Age, mean (SD) Male, (%) Hypertension, (%) Dyslipidemia, (%) Diabetes, (%) Current smoker, (%) Previous PCI, (%) Previous MI, (%) LVEF (%), mean (SD) Hypothermia, (%) Arrest Location Pre hospital, (%) Outside ED, (%) Transport, (%) PCI hospital ED, (%) CV lab, (%) Unknown, (%) Infarct Artery Left Main, (%) LAD, (%) LCx, (%) RCA, (%) Graft, (%) None, (%) Multiple, (%) Death prior to angiography, (%) Lesion Location Proximal, (%) Non-proximal, (%) No obstructive CAD, (%) Death prior to angiography, (%) Length-of-stay (days), median (25th, 75th percentile) Death in hospital, (%) Death at 1-year post discharge, (%)
Cardiac Arrest (Shockable Rhythm) Cardiogenic Shock No Cardiogenic Shock (n=156) (n=285) 64 ± 13 63 ± 13 113 (72) 224 (79) 90 (60) 154 (56) 73 (51) 145 (53) 23 (15) 42 (15) 56 (39) 111 (40) 27 (18) 52 (19) 37 (25) 53 (19) 36 ± 16 43 ± 14 65 (47) 90 (35)
P-Value 0.32 0.15 0.43 0.64 0.93 0.75 0.87 0.17 <0.001 0.019
Cardiac Arrest (Non-shockable Rhythm) Cardiogenic Shock No Cardiogenic Shock (n=29) (n=29) 65 ± 11 62 ± 16 13 (45) 18 (62) 16 (62) 18 (62) 12 (46) 12 (43) 5 (19) 8 (28) 15 (58) 12 (43) 5 (18) 5 (17) 8 (29) 4 (14) 35 ± 19 40 ± 15 11 (41) 12 (43)
P-Value 0.52 0.19 0.97 0.81 0.38 0.28 0.95 0.17 0.28 0.87
63 (40) 43 (28) 12 (8) 11 (7) 21 (13) 6 (4)
122 (43) 99 (35) 19 (7) 10 (4) 27 (9) 8 (3)
0.27
15 (52) 1 (3) 0 (0) 2 (7) 8 (28) 3 (10)
15 (52) 4 (14) 1 (3) 1 (3) 6 (21) 2 (7)
0.61
9 (6) 50 (32) 10 (6) 47 (30) 8 (5) 13 (8) 12 (8) 7 (5)
2 (1) 100 (35) 37 (13) 71 (25) 16 (6) 33 (12) 19 (7) 7 (2)
0.011
1 (3) 6 (21) 2 (7) 8 (28) 0 (0) 6 (21) 4 (14) 2 (7)
0 (0) 7 (24) 1 (3) 6 (21) 0 (0) 11 (38) 1 (3) 3 (10)
0.523
79 (51) 52 (33) 18 (12) 7 (4) 7 (3, 13) 65 (42) 7 (8)
127 (45) 111 (39) 40 (14) 7 (2) 4 (3, 8) 42 (15) 9 (4)
0.33
11 (38) 9 (31) 7 (24) 2 (7) 10 (2, 16) 17 (59) 1 (8)
8 (28) 6 (21) 12 (41) 3 (10) 5 (2, 10) 17 (59) 1 (8)
0.46
0.031 <0.001 0.13
0.16 1.00 1.00
Acute and Stable Ischemic Heart Disease INFLUENCE OF CARDIAC ARREST AND CARDIOGENIC SHOCK ON OUTCOMES AMONG 4,500 CONSECUTIVE ST ELEVATION MYOCARDIAL INFARCTION PATIENTS Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m. Session Title: Cardiac Arrest, Diabetes, and Other High Risk Features of Patients With Acute Coronary Syndrome Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical Presentation Number: 1204-346 Authors: Claire Donovan, Benjamin Johnson, Ross Garberich, John Hibbs, David Larson, Timothy Henry, Scott Sharkey, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA Background: The influence of cardiac arrest and cardiogenic shock on outcomes of patients with ST-elevation myocardial infarction (STEMI) in the percutaneous coronary intervention (PCI) era is incompletely studied.
Methods: We examined a regional STEMI network to determine incidence, characteristics and outcomes of STEMI complicated by cardiac arrest with and without cardiogenic shock. Cardiac arrest was classified as shockable (ventricular tachycardia/ventricular fibrillation) or nonshockable (asystole/pulseless electrical activity). Results: From March 2003 – December 2014, we enrolled 4,511 consecutive patients including 499 (11%) with cardiac arrest prior to PCI. The cardiac arrest was shockable in 441 (88%) patients and non-shockable in 58 (12%) patients.
Conclusions: In this contemporary STEMI population, most with cardiac arrest had no history of myocardial infarction or revascularization. Cardiogenic shock influenced hospital mortality only in those with shockable rhythm. A non-proximal coronary culprit was present in onethird of patients with shockable and non-shockable cardiac arrest and culprit coronary anatomy was no different in those with and without cardiogenic shock. Nearly 75% of patients with shockable arrest survived to discharge, 95% of whom were alive at 1 year. In contrast, only 40% of patients with non-shockable arrest survived to discharge, 92% of whom were alive at 1 year.
Age, mean (SD) Male, (%) Hypertension, (%) Dyslipidemia, (%) Diabetes, (%) Current smoker, (%) Previous PCI, (%) Previous MI, (%) LVEF (%), mean (SD) Hypothermia, (%) Arrest Location Pre hospital, (%) Outside ED, (%) Transport, (%) PCI hospital ED, (%) CV lab, (%) Unknown, (%) Infarct Artery Left Main, (%) LAD, (%) LCx, (%) RCA, (%) Graft, (%) None, (%) Multiple, (%) Death prior to angiography, (%) Lesion Location Proximal, (%) Non-proximal, (%) No obstructive CAD, (%) Death prior to angiography, (%) Length-of-stay (days), median (25th, 75th percentile) Death in hospital, (%) Death at 1-year post discharge, (%)
Cardiac Arrest (Shockable Rhythm) Cardiogenic Shock No Cardiogenic Shock (n=156) (n=285) 64 ± 13 63 ± 13 113 (72) 224 (79) 90 (60) 154 (56) 73 (51) 145 (53) 23 (15) 42 (15) 56 (39) 111 (40) 27 (18) 52 (19) 37 (25) 53 (19) 36 ± 16 43 ± 14 65 (47) 90 (35)
P-Value 0.32 0.15 0.43 0.64 0.93 0.75 0.87 0.17 <0.001 0.019
Cardiac Arrest (Non-shockable Rhythm) Cardiogenic Shock No Cardiogenic Shock (n=29) (n=29) 65 ± 11 62 ± 16 13 (45) 18 (62) 16 (62) 18 (62) 12 (46) 12 (43) 5 (19) 8 (28) 15 (58) 12 (43) 5 (18) 5 (17) 8 (29) 4 (14) 35 ± 19 40 ± 15 11 (41) 12 (43)
P-Value 0.52 0.19 0.97 0.81 0.38 0.28 0.95 0.17 0.28 0.87
63 (40) 43 (28) 12 (8) 11 (7) 21 (13) 6 (4)
122 (43) 99 (35) 19 (7) 10 (4) 27 (9) 8 (3)
0.27
15 (52) 1 (3) 0 (0) 2 (7) 8 (28) 3 (10)
15 (52) 4 (14) 1 (3) 1 (3) 6 (21) 2 (7)
0.61
9 (6) 50 (32) 10 (6) 47 (30) 8 (5) 13 (8) 12 (8) 7 (5)
2 (1) 100 (35) 37 (13) 71 (25) 16 (6) 33 (12) 19 (7) 7 (2)
0.011
1 (3) 6 (21) 2 (7) 8 (28) 0 (0) 6 (21) 4 (14) 2 (7)
0 (0) 7 (24) 1 (3) 6 (21) 0 (0) 11 (38) 1 (3) 3 (10)
0.523
79 (51) 52 (33) 18 (12) 7 (4) 7 (3, 13) 65 (42) 7 (8)
127 (45) 111 (39) 40 (14) 7 (2) 4 (3, 8) 42 (15) 9 (4)
0.33
11 (38) 9 (31) 7 (24) 2 (7) 10 (2, 16) 17 (59) 1 (8)
8 (28) 6 (21) 12 (41) 3 (10) 5 (2, 10) 17 (59) 1 (8)
0.46
0.031 <0.001 0.13
0.16 1.00 1.00