TY - JOUR
T1 - Cardiac arrest and clinical characteristics, treatments and outcomes among patients hospitalized with ST-elevation myocardial infarction in contemporary practice
T2 - A report from the National Cardiovascular Data Registry
AU - Kontos, Michael C.
AU - Scirica, Benjamin M.
AU - Chen, Anita Y.
AU - Thomas, Laine
AU - Anderson, Monique L.
AU - Diercks, Deborah B.
AU - Jollis, James G.
AU - Roe, Matthew T.
N1 - Funding Information:
The ACTION Registry-GWTG is a nationwide, ongoing, voluntary quality improvement registry sponsored by the American College of Cardiology and the American Heart Association (AHA) that focuses exclusively on patients with acute MI. Details of the design and conduct of the registry have been previously described. 19 This registry was either approved by an institutional review board or considered quality assurance data and not subject to institutional review board approval based on individual site determinations. 19 This research was supported by the American College of Cardiology Foundation's NCDR. The views expressed represent those of the authors and do not necessarily represent the official views of the NCDR or its associated professional societies identified at www.ncdr.com .
Publisher Copyright:
© 2015 Elsevier Inc. All rights reserved.
PY - 2015/4/1
Y1 - 2015/4/1
N2 - Background Cardiac arrest (CA) is a major complication of patients with ST-elevation myocardial infarction (STEMI). Its prevalence and prognostic impact in contemporary US practice has not been well assessed. Methods We evaluated STEMI patients included in the National Cardiovascular Data Registry (NCDR) Acute Coronary Treatment Intervention Outcomes Network Registry-Get With the Guidelines (ACTION Registry-GWTG) from 4/1/11 to 6/30/12. Patient clinical characteristics, treatments, and inhospital outcomes were compared by the presence or absence of CA on first medical contact - either before hospital arrival or upon presentation to the ACTION hospital. Results Of the 49,279 STEMI patients included, 3,716 (7.5%) had CA. Cardiac arrest patients were more likely to have heart failure (15.5% vs 6.9%) and shock (42.9% vs 4.9%) on presentation and higher median (25th and 75th percentiles) ACTION Registry-GWTG mortality risk scores (42 [32, 54] vs 32 [26, 38]) than non-CA patients (all P <.001). Primary percutaneous coronary intervention was performed in most patients with and without CA (76.7% vs 79.1%). Inhospital mortality was significantly higher in patients with than without CA (28.8% vs 4.0%; P <.001), both in patients who presented with cardiogenic shock (46.9% vs 27.1%; P <.001) and those without shock (15.4% vs 2.9%; P <.001). The ACTION Registry-GWTG inhospital mortality model underestimated mortality risk in CA patients; however, prediction significantly improved after adding CA to the model. Conclusions Almost 8% of STEMI patients present with CA. More than 25% die during the hospitalization, despite high use of primary percutaneous coronary intervention. Cardiogenic shock and CA frequently coexist. Our results suggest that development of systems of care and treatments for both STEMI and CA is needed to reduce the high mortality in these patients.
AB - Background Cardiac arrest (CA) is a major complication of patients with ST-elevation myocardial infarction (STEMI). Its prevalence and prognostic impact in contemporary US practice has not been well assessed. Methods We evaluated STEMI patients included in the National Cardiovascular Data Registry (NCDR) Acute Coronary Treatment Intervention Outcomes Network Registry-Get With the Guidelines (ACTION Registry-GWTG) from 4/1/11 to 6/30/12. Patient clinical characteristics, treatments, and inhospital outcomes were compared by the presence or absence of CA on first medical contact - either before hospital arrival or upon presentation to the ACTION hospital. Results Of the 49,279 STEMI patients included, 3,716 (7.5%) had CA. Cardiac arrest patients were more likely to have heart failure (15.5% vs 6.9%) and shock (42.9% vs 4.9%) on presentation and higher median (25th and 75th percentiles) ACTION Registry-GWTG mortality risk scores (42 [32, 54] vs 32 [26, 38]) than non-CA patients (all P <.001). Primary percutaneous coronary intervention was performed in most patients with and without CA (76.7% vs 79.1%). Inhospital mortality was significantly higher in patients with than without CA (28.8% vs 4.0%; P <.001), both in patients who presented with cardiogenic shock (46.9% vs 27.1%; P <.001) and those without shock (15.4% vs 2.9%; P <.001). The ACTION Registry-GWTG inhospital mortality model underestimated mortality risk in CA patients; however, prediction significantly improved after adding CA to the model. Conclusions Almost 8% of STEMI patients present with CA. More than 25% die during the hospitalization, despite high use of primary percutaneous coronary intervention. Cardiogenic shock and CA frequently coexist. Our results suggest that development of systems of care and treatments for both STEMI and CA is needed to reduce the high mortality in these patients.
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U2 - 10.1016/j.ahj.2015.01.010
DO - 10.1016/j.ahj.2015.01.010
M3 - Article
C2 - 25819858
AN - SCOPUS:84927570291
SN - 0002-8703
VL - 169
SP - 515-522.e1
JO - American heart journal
JF - American heart journal
IS - 4
ER -