Abstract
Background
There are limited data on the relationship of ST-segment-elevation myocardial infarction
(STEMI) management strategy and in-hospital cardiac arrest (IHCA).
Aims
To investigate the trends and outcomes of IHCA in STEMI by management strategy.
Methods
Adult with STEMI complicated by IHCA from the National Inpatient Sample (2000–2017)
were stratified into early percutaneous coronary intervention (PCI) (day 0 of hospitalization),
delayed PCI (PCI ≥ day 1), or medical management (no PCI). Coronary artery bypass
surgery was excluded. Outcomes of interest included in-hospital mortality, adverse
events, length of stay, and hospitalization costs.
Results
Of 3,967,711 STEMI admissions, IHCA was noted in 102,424 (2.6%) with an increase in
incidence during this study period. Medically managed STEMI had higher rates of IHCA
(3.6% vs 2.0% vs 1.3%, p < 0.001) compared to early and delayed PCI, respectively. Revascularization was associated
with lower rates of IHCA (early PCI: adjusted odds ratio [aOR] 0.44 [95% confidence
interval (CI) 0.43–0.44], p < 0.001; delayed PCI aOR 0.33 [95% CI 0.32–0.33], p < 0.001) compared to medical management. Non-revascularized patients had higher rates
of non-shockable rhythms (62% vs 35% and 42.6%), but lower rates of multiorgan damage
(44% vs 52.7% and 55.6%), cardiogenic shock (28% vs 65% and 57.4%) compared to early
and delayed PCI, respectively (all p < 0.001). In-hospital mortality was lower with early PCI (49%, aOR 0.18, 95% CI 0.17–0.18),
and delayed PCI (50.9%, aOR 0.18, 95% CI 0.17–0.19) (p < 0.001) compared to medical management (82.5%).
Conclusion
Early PCI in STEMI impacts the natural history of IHCA including timing and type of
IHCA.
Keywords
Abbreviations:
AMI (acute myocardial infarction), CA (coronary angiogram), CABG (coronary artery bypass grafting), CI (confidence interval), HCUP (Healthcare Cost and Utilization Project), ICD-9CM (International Classification of Diseases-9 Clinical Modification), ICD-10CM (International Classification of Diseases-10 Clinical Modification), IHCA (in-hospital cardiac arrest), MCS (mechanical circulatory support), NIS (National/Nationwide Inpatient Sample), OR (odds ratio), STEMI (ST-segment-elevation myocardial infarction)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 21, 2023
Accepted:
February 15,
2023
Received in revised form:
February 14,
2023
Received:
November 23,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier B.V. All rights reserved.
