Abstract 10962: Long-term Clinical Impact of Cardiac Arrest in Patients With First Onset Acute ST-segment Elevation Myocardial Infarction
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 long-term outcomes after cardiac arrest. We aimed to find risk factors for cardiac arrest complicating STEMI and short- and long-term clinical outcomes.
Methods: We analyzed consecutive 8,201 STEMI patients (66.2±12.9 years old, 6,049 males) who were diagnosed STEMI and had no previous history of MI enrolled in Korean AMI Registry (KAMIR). They were divided into two groups according to the presence of cardiac arrest (Group I, patients with cardiac arrest; n=503, Group II, patients without cardiac arrest; n=7,698).
Results: Group I had significantly higher previous history of smoking, chronic renal disease (CKD), cerebrovascular accident (CVA) and lower serum level of high-density lipoprotein cholesterol (HDL-C), higher that of glucose. Group I had higher in-hospital mortality (27.6% vs. 3.9%, p<0.001) and multi-organ failure (6.4% vs. 2.2%, p<0.001). In stepwise multivariate model, CKD (HR 2.39, 95% CI 1.24-4.59), previous history of CVA (HR 1.59, 95% CI 1.04-2.42), serum glucose level ≥200 mg/dl (HR 3.86, 95% CI 3.03-4.91) and HDL-C < 40 mg/dL (HR 1.28, 95% CI 1.01-1.61) were independent predictor of cardiac arrest complicating STEMI. Group I had significantly higher 30 day mortality (HR 3.75, 95% CI 2.01-7.00, log-rank p<0.001). Although in Kaplan-Meier curve the higher mortality rate in cardiac arrest patients extends to one year, there were no significant increase in mortality beyond 30 days (6 month, HR 1.47, 95% CI 0.54-4.05, log rank p=0.451; 1 year HR 1.67, 95% CI 0.81-3.42, log-rank p=0.158). Also, there were no significant differences in 6 month and 1-year major adverse cardiac events including death, recurrent MI, and target vessel revascularization in patients who survived more than 30 days.
Conclusions: Patients with CKD, CVA and high serum glucose level might have increased chance of cardiac arrest complicating STEMI. Although patients with cardiac arrest had higher in-hospital and 30-days post discharge mortality, cardiac arrest itself did not have any residual impact on mortality as well as clinical outcomes.
- © 2013 by American Heart Association, Inc.