Pre-percutaneous coronary intervention sudden cardiac arrest in ST-elevation myocardial infarction: Incidence, predictors, and related outcomes

Guilherme Pinheiro Machado; Andre Luiz Theobald; Gustavo Neves de Araujo; Anderson Donelli da Silveira; Rodrigo Vugman Wainstein; Julia Fagundes Fracasso; Matheus Niches; Angelo Chies; Sandro Cadaval Goncalves; Mauricio Pimentel; Marco Vugman Wainstein

doi:10.3389/fcvm.2023.1100187

Pre-percutaneous coronary intervention sudden cardiac arrest in ST-elevation myocardial infarction: Incidence, predictors, and related outcomes

Front Cardiovasc Med. 2023 Feb 16:10:1100187. doi: 10.3389/fcvm.2023.1100187. eCollection 2023.

Authors

Guilherme Pinheiro Machado^{1

2}, Andre Luiz Theobald^{1

2}, Gustavo Neves de Araujo^{3

4}, Anderson Donelli da Silveira^{1

2}, Rodrigo Vugman Wainstein^{1

2}, Julia Fagundes Fracasso⁵, Matheus Niches⁵, Angelo Chies⁵, Sandro Cadaval Goncalves^{1

2}, Mauricio Pimentel^{1

2}, Marco Vugman Wainstein^{1

2

5}

Affiliations

¹ Postgraduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
² Department of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
³ Imperial Hospital de Caridade, Florianópolis, Brazil.
⁴ Instituto de Cardiologia de Santa Catarina, São Jose, Brazil.
⁵ School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

Abstract

Background: ST-segment elevation myocardial infarction (STEMI) is a frequent cause of sudden cardiac arrest (SCA) and early percutaneous coronary intervention (PCI) is associated with increased survival. Despite constant improvements in SCA management, survival remains poor. We aimed to assess pre-PCI SCA incidence and related outcomes in patients admitted with STEMI.

Methods: This was a prospective cohort study of patients admitted with STEMI in a tertiary university hospital over 11 years. All patients were submitted to emergency coronary angiography. Baseline characteristics, details of the procedure, reperfusion strategies, and adverse outcomes were assessed. The primary outcome was in-hospital mortality. The secondary outcome was 1-year mortality after hospital discharge. Predictors of pre-PCI SCA was also assessed.

Results: During the study period 1,493 patients were included; the mean age was 61.1 years (±12), and 65.3% were male. Pre-PCI SCA was present in 133 (8.9%) patients. In-hospital mortality was higher in the pre-PCI SCA group (36.8% vs. 8.8%, p < 0.0001). In multivariate analysis, anterior MI, cardiogenic shock, age, pre-PCI SCA and lower ejection fraction remained significantly associated with in-hospital mortality. When we analyzed the interaction between pre-PCI SCA and cardiogenic shock upon admission there is a further increase in mortality risk when both conditions are present. For predictors of pre-PCI SCA, only younger age and cardiogenic shock remained significantly associated after multivariate analysis. Overall 1-year mortality rates were similar between pre-PCI SCA survivors and non-pre-PCI SCA group.

Conclusion: In a cohort of consecutive patients admitted with STEMI, pre-PCI SCA was associated with higher in-hospital mortality, and its association with cardiogenic shock further increases mortality risk. However, long-term mortality among pre-PCI SCA survivors was similar to non-SCA patients. Understanding characteristics associated with pre-PCI SCA may help to prevent and improve the management of STEMI patients.

Keywords: ST-elevation acute myocardial infarction; cardiogenic shock; mortality; percutaneous coronary intervention; sudden cardiac arrest.