Cardiac arrest and post-discharge mortality in patients with myocardial infarction: A large-scale nationwide registry analysis

Hirohiko Ando; Mitsuaki Sawano; Shun Kohsaka; Hideki Ishii; Atomu Tajima; Wataru Suzuki; Ayako Kunimura; Yusuke Nakano; Ken Kozuma; Tetsuya Amano

doi:10.1016/j.resplu.2024.100647

Cardiac arrest and post-discharge mortality in patients with myocardial infarction: A large-scale nationwide registry analysis

Resusc Plus. 2024 May 3:18:100647. doi: 10.1016/j.resplu.2024.100647. eCollection 2024 Jun.

Authors

Affiliations

¹ Department of Cardiology, Aichi Medical University, Nagakute, Japan.
² Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, Yale New Haven Hospital Center of Outcomes Research and Evaluation, New Haven, CT, USA.
³ Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
⁴ Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.
⁵ Department of Cardiology, Teikyo University, Tokyo, Japan.

Abstract

Background: Cardiac arrest is a serious complication of acute myocardial infarction. The implementation of contemporary approaches to acute myocardial infarction management, including urgent revascularization procedures, has led to significant improvements in short-term outcomes. However, the extent of post-discharge mortality in patients experiencing cardiac arrest during acute myocardial infarction remains uncertain. This study aimed to determine the post-discharge outcomes of patients with cardiac arrest.

Methods: We analysed data from the J-PCI OUTCOME registry, a Japanese prospectively planed, observational, multicentre, national registry of percutaneous coronary intervention involving consecutive patients from 172 institutions who underwent percutaneous coronary intervention and were discharged. Patients who underwent percutaneous coronary intervention for acute myocardial infarction between January 2017 and December 2018 and survived for 30 days were included. Mortality in patients with and without cardiac arrest from 30 days to 1 year after percutaneous coronary intervention for acute myocardial infarction was compared.

Results: Of the 26,909 patients who survived for 30 days after percutaneous coronary intervention for acute myocardial infarction, 1,567 (5.8%) had cardiac arrest at the onset of acute myocardial infarction. Patients with cardiac arrest were younger and more likely to be males than patients without cardiac arrest. The 1-year all-cause mortality was significantly higher in patients with cardiac arrest than in those without (11.9% vs. 2.8%, p < 0.001) for all age groups. Multivariable analysis showed that cardiac arrest was an independent predictor of all-cause long-term mortality (hazard ratio: 2.94; 95% confidence interval: 2.29-3.76).

Conclusions: Patients with acute myocardial infarction and concomitant cardiac arrest have a worse prognosis for up to 1 year after percutaneous coronary intervention than patients without cardiac arrest.

Keywords: Acute myocardial infarction; Cardiac arrest; J-PCI OUTCOME registry; Post-discharge mortality; Prognosis.