Dados do Trabalho

Título

Pre-admission Cardiac arrest in ST-segment elevation myocardial infarction: incidence, predictors and related outcomes

Fundamentação/Introdução

Introdução/ Fundamentos: ST segment elevation myocardial infarction (STEMI) is a frequent cause of Cardiac Arrest (CA), and early percutaneous coronary intervention is associated with increased hospital survival in these patients.

Objetivos

Objetivos: Our aim was to assess pre-admission CA incidence, predictors and related outcomes in patients admitted with STEMI.

Delineamento e Métodos

Delineamento/ Métodos: We prospectively included 875 patients admitted with STEMI in a tertiary university hospital in southern Brazil between March 2011 and December 2018. All patients were submitted to emergency coronary angiography. Baseline characteristics, details of the procedure, reperfusion strategies, and in-hospital outcomes were evaluated.

Resultados

Resultados: Mean age was 60 years (± 12), 67% were male, 62% had hypertension and 24% had diabetes. Pre-admission CA was present in 81 (9.25%) patients. Patients with CA had more frequently previous myocardial infarction, previous ASA use, temporary pacemaker, smoking and killip 3 or 4 on admission, and longer pain–to-door time than patients without CA. In addition, CA patients had a higher incidence of periprocedural CA, cardiogenic shock and periprocedural and in-hospital mortality. In multivariate analysis, age <65 years (OR= 2.05, p=0.049), smoking (OR=0.49, p=0.030), previous ASA use (OR=0.38, p= 0.047), Killip 3 or 4 (OR=14.36, p < 0.001), pain-to-door time (OR=0.92, p=0.038) and ejection fraction ≤40% (OR=1.961, p=0.054) were independently associated with CA. Non Shockable Rhythm (OR=14.86, p= 0.03), ROSC duration (OR=1.043, p= 0.045) and cardiogenic shock (OR=32.91, p=0.007) were independent predictors of mortality among patients admitted with CA.

Conclusões/Considerações finais

Conclusões/ Considerações finais: In this cohort of consecutive patients admitted with STEMI, pre-admission CA incidence was greater than seen in literature. Cardiogenic shock and in-hospital mortality were more common in patients admitted with CA, which may in part explain our higher rate of overall in-hospital mortality. Non shockable rhythm, increased ROSC and cardiogenic shock were independent predictors of mortality among patients admitted with CA. Understanding these characteristics may help taking measures to lower mortality rates.

Palavras-chave

STEMI; cardiac arrest

Área

Clínica Médica