Cardiac arrest and clinical characteristics, treatments and outcomes among patients hospitalized with ST-elevation myocardial infarction in contemporary practice

A report from the National Cardiovascular Data Registry

Michael C. Kontos, Benjamin M. Scirica, Anita Y. Chen, Laine Thomas, Monique L. Anderson, Deborah B. Diercks, James G. Jollis, Matthew T. Roe

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)515-522.e1
JournalAmerican Heart Journal
Volume169
Issue number4
DOIs
StatePublished - Apr 1 2015

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Heart Arrest
Registries
Cardiogenic Shock
Guidelines
Percutaneous Coronary Intervention
Hospital Mortality
Mortality
ST Elevation Myocardial Infarction
Shock
Hospitalization
Heart Failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Cardiac arrest and clinical characteristics, treatments and outcomes among patients hospitalized with ST-elevation myocardial infarction in contemporary practice : A report from the National Cardiovascular Data Registry. / Kontos, Michael C.; Scirica, Benjamin M.; Chen, Anita Y.; Thomas, Laine; Anderson, Monique L.; Diercks, Deborah B.; Jollis, James G.; Roe, Matthew T.

In: American Heart Journal, Vol. 169, No. 4, 01.04.2015, p. 515-522.e1.

Research output: Contribution to journalArticle

Kontos, Michael C. ; Scirica, Benjamin M. ; Chen, Anita Y. ; Thomas, Laine ; Anderson, Monique L. ; Diercks, Deborah B. ; Jollis, James G. ; Roe, Matthew T. / Cardiac arrest and clinical characteristics, treatments and outcomes among patients hospitalized with ST-elevation myocardial infarction in contemporary practice : A report from the National Cardiovascular Data Registry. In: American Heart Journal. 2015 ; Vol. 169, No. 4. pp. 515-522.e1.
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abstract = "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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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.

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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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