Clinical Characteristics and Outcomes of STEMI Patients With Cardiogenic Shock and Cardiac Arrest

Omer, Mohamed; Tyler, Jeffrey; Henry, Timothy D.; Garberich, Ross; Sharkey, Scott W.; Schmidt, Christian; Henry, Jason; Eckman, Peter; Megaly, Michael; Brilakis, Emmanouil S.; Chavez, Ivan; Burke, M. Nicholas; Gössl, Mario; Mooney, M.; Sorajja, Paul; Traverse, Jay H.; Wang, Yale; Hryniewicz, Katarzyna; García, Santiago

doi:10.1016/j.jcin.2020.04.004

Cited by 67 publications

(36 citation statements)

References 30 publications

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“…Our findings are consistent with a recently published study describing outcomes of patients with STEMI and CA from 2003 to 2014. 15 Our risk score, which demonstrated excellent predictive accuracy of early prognosis and outperformed the CathPCI Risk Score System, highlights the heterogeneity of STEMI-associated CA. This spectrum encompasses patients who develop a shockable rhythm and prompt return to spontaneous circulation without cardiogenic shock to those with refractory CA, concomitant cardiogenic shock, and poor neurologic outcome.…”

Section: Discussionmentioning

confidence: 81%

Prognostic implications and outcomes of cardiac arrest among contemporary patients with STEMI treated with PCI

et al. 2021

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Background Cardiac arrest (CA) complicating ST-elevation myocardial infarction (STEMI) is associated with a disproportionately higher risk of mortality. We described the contemporary presentation, management, and outcomes of CA patients in the era of primary percutaneous coronary intervention (PCI). Methods We reviewed 1,272 consecutive STEMI patients who underwent PCI between 1/1/2011-12/31/2016 and compared characteristics and outcomes between non-CA (N = 1,124) and CA patients (N = 148), defined per NCDR definitions as pulseless arrest requiring cardiopulmonary resuscitation and/or defibrillation within 24-hr of PCI. Results Male gender, cerebrovascular disease, chronic kidney disease, in-hospital STEMI, left main or left anterior descending culprit vessel, and initial TIMI 0 or 1 flow were independent predictors for CA. CA patients had longer door-to-balloon-time (106 [83,139] vs. 97 [74,121] minutes, p = 0.003) and greater incidence of cardiogenic shock (48.0% vs. 5.9%, p < 0.001), major bleeding (25.0% vs. 9.4%, p < 0.001), and 30-day mortality (16.2% vs. 4.1%, p < 0.001). Risk score for 30-day mortality based on presenting characteristics provided excellent prognostic accuracy (area under the curve = 0.902). However, over long-term follow-up of 4.5 ± 2.4 years among hospital survivors, CA did not portend any additional mortality risk (HR: 1.01, 95% CI: 0.56–1.82, p = 0.97). Conclusions In a contemporary cohort of STEMI patients undergoing primary PCI, CA occurs in >10% of patients and is an important mechanism of mortality in patients with in-hospital STEMI. While CA is associated with adverse outcomes, it carries no additional risk of long-term mortality among survivors highlighting the need for strategies to improve the in-hospital care of STEMI patients with CA.

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Section: Discussionmentioning

confidence: 81%

Prognostic implications and outcomes of cardiac arrest among contemporary patients with STEMI treated with PCI

et al. 2021

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“…CS is a lethal complication of STEMI with an incidence of ~8-12% and 30-day mortality of 40% to 55% [7] , [22] , [23] . Concurrent cardiac arrest almost doubled hospital mortality secondary to CS [24] . Early revascularization of the culprit vessel is critical and associated with short- and long-term survival benefits [7] , [25] .…”

Section: Challenges In Stemi Carementioning

confidence: 98%

“…Despite limited randomized trials with a lack of survival benefit, mechanical circulatory support (MCS) has been increasingly used in CS [7] , [22] , [23] , [24] , [25] , [26] , [28] . The recent scientific statement by AHA proposed that STEMI patients complicated by CS (SACI shock stages from C to E) may benefit from MCS devices in case of persistent hemodynamic instability.…”

Section: Challenges In Stemi Carementioning

confidence: 99%

STEMI care 2021: Addressing the knowledge gaps

Yıldız

Wade

Henry

2021

American Heart Journal Plus: Cardiology Research and Practice

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Tremendous progress has been made in the treatment of ST-segment elevation myocardial infarction (STEMI), the most severe and time-sensitive acute coronary syndrome. Primary percutaneous coronary intervention (PCI) is the preferred method of reperfusion, which has stimulated the development of regional STEMI systems of care with standardized protocols designed to optimize care. However, challenges remain for patients with cardiogenic shock, out-of-hospital cardiac arrest, an expected delay to reperfusion (>120 min), in-hospital STEMI, and more recently, those with Covid-19 infection. Ultimately, the goal is to provide timely reperfusion with primary PCI coupled with the optimal antiplatelet and anticoagulant therapies. We review the challenges and provide insights into the remaining knowledge gaps for contemporary STEMI care.

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“…8,11 Previous data from our group and others have shown that the combination of CS and CA is associated with worse shortand long-term mortality than either CA or CS alone. 12,13 In addition to the high in-hospital mortality and resource utilization, patients with CS and CA complicating AMI remain vulnerable after discharge, with nearly 20% readmission rates within 30 to 90 days. 7,14,15 With the increasing emphasis on reducing hospitalizations to alleviate health care costs in the United States, it is crucial to understand the long-term health care utilization patterns in patients with CS or CA.…”

mentioning

confidence: 99%

“…7,15 Although previous data have shown that CS is associated with high health care resource utilization after discharge, 7,15 the modulating effect of CA in patients with AMI is less understood. 8,11,13 Using a large administrative database, we sought to evaluate the use of posteacute care services, emergency department (ED) visits, and readmissions in survivors of AMI complicated by CA and CS. We hypothesized that AMI survivors with CA and CS during the index hospitalization would have a higher risk of readmissions, ED visits, and use of posteacute care services than AMI survivors with either CA or CS alone.…”

mentioning

confidence: 99%

Use of Post–Acute Care Services and Readmissions After Acute Myocardial Infarction Complicated by Cardiac Arrest and Cardiogenic Shock

Vallabhajosyula

Payne

Jentzer

et al. 2021

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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Objective: To evaluate posteacute care utilization and readmissions after cardiac arrest (CA) and cardiogenic shock (CS) complicating acute myocardial infarction (AMI). Methods: With use of an administrative claims database, AMI patients from January 1, 2010, to May 31, 2018, were stratified into CAþCS, CA only, CS only, and AMI alone. Outcomes included 90-day posteacute care (inpatient rehabilitation or skilled nursing facility) utilization and 1-year emergency department visits and readmissions. Results: Of 163,071 AMI patients, CAþCS, CA only, and CS only were noted in 3965 (2.4%), 8221 (5.0%), and 6559 (4.0%), respectively. In-hospital mortality was noted in 10,686 (6.6%) patients:

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Clinical Characteristics and Outcomes of STEMI Patients With Cardiogenic Shock and Cardiac Arrest

Cited by 67 publications

References 30 publications

Prognostic implications and outcomes of cardiac arrest among contemporary patients with STEMI treated with PCI

Prognostic implications and outcomes of cardiac arrest among contemporary patients with STEMI treated with PCI

STEMI care 2021: Addressing the knowledge gaps

Use of Post–Acute Care Services and Readmissions After Acute Myocardial Infarction Complicated by Cardiac Arrest and Cardiogenic Shock

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