One-year clinical impact of cardiac arrest in patients with first onset acute ST-segment elevation myocardial infarction

Abstract Background Cardiac arrest complicating acute ST elevation myocardial infarction (STEMI) is known to be associated with increased in-hospital mortality. However, little is known about the long-term outcomes after cardiac arrest complicating first onset STEMI in contemporary percutaneous coro...

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Published in:International journal of cardiology 2014-07, Vol.175 (1), p.147-153
Main Authors: Lee, Ki Hong, Jeong, Myung Ho, YoungkeunAhn, Kim, Sung Soo, Rhew, Shi Hyun, Jeong, Young Wook, Jang, Soo Young, Cho, Jae Yeong, Jeong, Hae Chang, Park, Keun-Ho, Yoon, Nam Sik, Sim, Doo Sun, Yoon, Hyun Ju, Kim, Kye Hun, Hong, Young Joon, Park, Hyung Wook, Kim, Ju Han, Cho, Jeong Gwan, Park, Jong Chun, Cho, Myeong Chan, Kim, Chong Jin, Kim, Young Jo
Format: Article
Language:English
Subjects:
Acute Disease
Aged
Biological and medical sciences
Cardiac
Cardiology. Vascular system
Cardiovascular
Coronary heart disease
Death
Female
Follow-Up Studies
Heart
Heart arrest
Heart Arrest - diagnosis
Heart Arrest - mortality
Hospital Mortality - trends
Humans
Male
Medical sciences
Middle Aged
Myocardial infarction
Myocardial Infarction - diagnosis
Myocardial Infarction - mortality
Myocarditis. Cardiomyopathies
Prospective Studies
Registries
Republic of Korea - epidemiology
Sudden
Survival Rate - trends
Time Factors
Treatment Outcome
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Summary:Abstract Background Cardiac arrest complicating acute ST elevation myocardial infarction (STEMI) is known to be associated with increased in-hospital mortality. However, little is known about the long-term outcomes after cardiac arrest complicating first onset STEMI in contemporary percutaneous coronary intervention (PCI) era. Methods We analyzed 7942 consecutive patients who were diagnosed with STEMI and had no previous history of MI. They were divided into two groups according to the presence of cardiac arrest (group I, patients with cardiac arrest; n = 481, group II, patients without cardiac arrest; n = 7641). Results In a stepwise multivariate model, previous history of chronic kidney disease, high serum level of glucose and low high density lipoprotein-cholesterol was an independent predictor of cardiac arrest complicating STEMI. Group I had significantly higher in-hospital mortality (adjusted hazard ratio [HR] 3.06, 95% confidence interval [CI] 2.08–4.51, p < 0.001) and 30-day mortality after hospital discharge (adjusted HR 2.92, 95% CI 1.86–4.58, log-rank p < 0.001). However, there was no significant increase in mortality beyond 30 days (6-month, adjusted HR 1.46, 95% CI 0.45–4.77, log rank p = 0.382; 1-year, adjusted HR 1.84, 95% CI 0.83–4.05, log-rank p = 0.107). Also, there were no significant differences in 6-month and 1-year major adverse cardiac events in 30-day survivors. Performing PCI was associated with decreased 12-month mortality in 30-day survivors. Conclusions Although patients with cardiac arrest complicating first onset STEMI had higher in-hospital and 30-day mortality after hospital discharge, cardiac arrest itself did not have any residual impact on mortality as well as clinical outcomes.
ISSN:0167-5273
1874-1754
DOI:10.1016/j.ijcard.2014.05.002