Nicole Karam1,2,3,4, Sophie Bataille5, Eloi Marijon1,2,3,4, Muriel Tafflet1,3,4, Hakim Benamer6, Christophe Caussin7, Philippe Garot8, Jean-Michel Juliard9, Virginie Pires10, Thévy Boche11, François Dupas12, Gaelle Le Bail13, Lionel Lamhaut14, Benoît Simon15, Alexandre Allonneau16, Mireille Mapouata5, Aurélie Loyeau5, Jean-Philippe Empana1,3,4, Frederic Lapostolle17, Christian Spaulding1,2,3,4, Xavier Jouven1,2,3,4, Yves Lambert18. 1. INSERM Unit 970, Cardiovascular Epidemiology, Paris, France (N.K., E.M., M.T., J.-P.E., C.S., X.J.). 2. Cardiology Department, European Georges Pompidou Hospital-APHP, Paris, France (N.K., E.M., C.S., X.J.). 3. Faculty of Medicine, Paris Descartes University, France (N.K., E.M., M.T., J.-P.E., C.S., X.J.). 4. Sudden Death Expertise Center, Paris, France (N.K., E.M., M.T., J.-P.E., C.S. X.J.). 5. Regional Health Agency of Ile-de-France, Paris, France (S.B., M.M., A.L.). 6. Cardiology Department, Institut Cardiovasculaire Paris Sud, Massy, France (H.B.). 7. Cardiology Department, Institut Mutualiste Montsouris, Paris, France (C.C.). 8. Cardiology Department, Institut Cardiovasculaire Paris Sud, Quincy sous Sénart, France (P.G.). 9. Cardiology Department, Bichat Hospital-APHP, Paris, France (J.-M.J.). 10. SAMU 77, Melun Hospital, France (V.P.). 11. SAMU 94, Mondor Hospital-APHP, Créteil, France (T.B.). 12. SAMU 95, Pontoise Hospital, France (F.D.). 13. SAMU 92, Garches Hospital-APHP, France (G.L.B.). 14. SAMU 75, Necker Hospital-APHP, Paris, France (L.L.). 15. SAMU 91, Sud Francilien Hospital, Corbeil-Essonnes, France (B.S.). 16. Fire Brigade of Paris, France (A.A.). 17. SAMU 93, Avicenne Hospital-APHP, Bobigny, France (F.L.). 18. SAMU 78, Versailles Hospital, Le Chesnay, France (Y.L.).
Abstract
BACKGROUND: Mortality of ST-segment-elevation myocardial infarction (STEMI) decreased drastically, mainly through reduction in inhospital mortality. Prehospital sudden cardiac arrest (SCA) became one of the most feared complications. We assessed the incidence, outcome, and prognosis' predictors of prehospital SCA occurring after emergency medical services (EMS) arrival. METHODS AND RESULTS: Data were taken between 2006 and 2014 from the e-MUST study (Evaluation en Médecine d'Urgence des Strategies Thérapeutiques des infarctus du myocarde) that enrolls all STEMI managed by EMS in the Greater Paris Area, including those dead before hospital admission. Among 13 253 STEMI patients analyzed, 749 (5.6%) presented EMS-witnessed prehospital SCA. Younger age, absence of cardiovascular risk factors, symptoms of heart failure, extensive STEMI, and short pain onset-to-call and call-to-EMS arrival delays were independently associated with increased SCA risk. Mortality rate at hospital discharge was 4.0% in the nonSCA group versus 37.7% in the SCA group ( P<0.001); 26.8% of deaths occurred before hospital admission. Factors associated with increased mortality after SCA were age, heart failure, and extensive STEMI, while male sex and cardiovascular risk factors were associated with decreased mortality. Among patients admitted alive, PCI was the most important mortality-reduction predictor (odds ratio, 0.40; 95% CI, 0.25-0.63; P<0.0001). CONCLUSIONS: More than 1 of 20 STEMI presents prehospital SCA after EMS arrival. SCA occurrence is associated with a 10-fold higher mortality at hospital discharge compared with STEMI without SCA. PCI is the strongest survival predictor, leading to a twice-lower mortality. This highlights the persistently dramatic impact of SCA on STEMI and the major importance of PCI in this setting.
BACKGROUND:Mortality of ST-segment-elevation myocardial infarction (STEMI) decreased drastically, mainly through reduction in inhospital mortality. Prehospital sudden cardiac arrest (SCA) became one of the most feared complications. We assessed the incidence, outcome, and prognosis' predictors of prehospital SCA occurring after emergency medical services (EMS) arrival. METHODS AND RESULTS: Data were taken between 2006 and 2014 from the e-MUST study (Evaluation en Médecine d'Urgence des Strategies Thérapeutiques des infarctus du myocarde) that enrolls all STEMI managed by EMS in the Greater Paris Area, including those dead before hospital admission. Among 13 253 STEMI patients analyzed, 749 (5.6%) presented EMS-witnessed prehospital SCA. Younger age, absence of cardiovascular risk factors, symptoms of heart failure, extensive STEMI, and short pain onset-to-call and call-to-EMS arrival delays were independently associated with increased SCA risk. Mortality rate at hospital discharge was 4.0% in the nonSCA group versus 37.7% in the SCA group ( P<0.001); 26.8% of deaths occurred before hospital admission. Factors associated with increased mortality after SCA were age, heart failure, and extensive STEMI, while male sex and cardiovascular risk factors were associated with decreased mortality. Among patients admitted alive, PCI was the most important mortality-reduction predictor (odds ratio, 0.40; 95% CI, 0.25-0.63; P<0.0001). CONCLUSIONS: More than 1 of 20 STEMI presents prehospital SCA after EMS arrival. SCA occurrence is associated with a 10-fold higher mortality at hospital discharge compared with STEMI without SCA. PCI is the strongest survival predictor, leading to a twice-lower mortality. This highlights the persistently dramatic impact of SCA on STEMI and the major importance of PCI in this setting.
Authors: Andy T Tran; Anthony J Hart; John A Spertus; Philip G Jones; Bryan F McNally; Ali O Malik; Paul S Chan Journal: Resuscitation Date: 2021-12-27 Impact factor: 5.262
Authors: Oriol Rodríguez-Leor; Belén Cid-Álvarez; Armando Pérez de Prado; Xavier Rossello; Soledad Ojeda; Ana Serrador; Ramón López-Palop; Javier Martín-Moreiras; José Ramón Rumoroso; Ángel Cequier; Borja Ibáñez; Ignacio Cruz-González; Rafael Romaguera; Raúl Moreno; Manuel Villa; Rafael Ruíz-Salmerón; Francisco Molano; Carlos Sánchez; Erika Muñoz-García; Luís Íñigo; Juan Herrador; Antonio Gómez-Menchero; Antonio Gómez-Menchero; Juan Caballero; Soledad Ojeda; Mérida Cárdenas; Livia Gheorghe; Jesús Oneto; Francisco Morales; Félix Valencia; José Ramón Ruíz; José Antonio Diarte; Pablo Avanzas; Juan Rondán; Vicente Peral; Lucía Vera Pernasetti; Julio Hernández; Francisco Bosa; Pedro Luís Martín Lorenzo; Francisco Jiménez; José M de la Torre Hernández; Jesús Jiménez-Mazuecos; Fernando Lozano; José Moreu; Enrique Novo; Javier Robles; Javier Martín Moreiras; Felipe Fernández-Vázquez; Ignacio J Amat-Santos; Joan Antoni Gómez-Hospital; Joan García-Picart; Bruno García Del Blanco; Ander Regueiro; Xavier Carrillo-Suárez; Helena Tizón; Mohsen Mohandes; Juan Casanova; Víctor Agudelo-Montañez; Juan Francisco Muñoz; Juan Franco; Roberto Del Castillo; Pablo Salinas; Jaime Elizaga; Fernando Sarnago; Santiago Jiménez-Valero; Fernando Rivero; Juan Francisco Oteo; Eduardo Alegría-Barrero; Ángel Sánchez-Recalde; Valeriano Ruíz; Eduardo Pinar; Eduardo Pinar; Ana Planas; Bernabé López Ledesma; Alberto Berenguer; Agustín Fernández-Cisnal; Pablo Aguar; Francisco Pomar; Miguel Jerez; Francisco Torres; Ricardo García; Araceli Frutos; Juan Miguel Ruíz Nodar; Koldobika García; Roberto Sáez; Alfonso Torres; Miren Tellería; Mario Sadaba; José Ramón López Mínguez; Juan Carlos Rama Merchán; Javier Portales; Ramiro Trillo; Guillermo Aldama; Saleta Fernández; Melisa Santás; María Pilar Portero Pérez Journal: Rev Esp Cardiol Date: 2020-10-09 Impact factor: 4.753
Authors: Mohamed A Omer; Jose E Exaire; Jacob C Jentzer; Yader B Sandoval; Mandeep Singh; Charles R Cagin; Islam Y Elgendy; Tahir Tak Journal: Int J Angiol Date: 2021-02-12
Authors: Timothy N Jones; Matthew Kelham; Krishnaraj S Rathod; Charles J Knight; Alastair Proudfoot; Ajay K Jain; Andrew Wragg; Muhiddin Ozkor; Paul Rees; Oliver Guttmann; Andreas Baumbach; Anthony Mathur; Daniel A Jones Journal: Am J Cardiovasc Dis Date: 2021-12-15
Authors: Petr Toušek; David Bauer; Marek Neuberg; Markéta Nováčková; Petr Mašek; Petr Tu Ma; Viktor Kočka; Zuzana Moťovská; Petr Widimský Journal: Eur Heart J Suppl Date: 2022-03-30 Impact factor: 1.624
Authors: Oriol Rodríguez-Leor; Belén Cid-Álvarez; Armando Pérez de Prado; Xavier Rossello; Soledad Ojeda; Ana Serrador; Ramón López-Palop; Javier Martín-Moreiras; José Ramón Rumoroso; Ángel Cequier; Borja Ibáñez; Ignacio Cruz-González; Rafael Romaguera; Raúl Moreno; Manuel Villa; Rafael Ruíz-Salmerón; Francisco Molano; Carlos Sánchez; Erika Muñoz-García; Luís Íñigo; Juan Herrador; Antonio Gómez-Menchero; Antonio Gómez-Menchero; Juan Caballero; Soledad Ojeda; Mérida Cárdenas; Livia Gheorghe; Jesús Oneto; Francisco Morales; Félix Valencia; José Ramón Ruíz; José Antonio Diarte; Pablo Avanzas; Juan Rondán; Vicente Peral; Lucía Vera Pernasetti; Julio Hernández; Francisco Bosa; Pedro Luís Martín Lorenzo; Francisco Jiménez; José M de la Torre Hernández; Jesús Jiménez-Mazuecos; Fernando Lozano; José Moreu; Enrique Novo; Javier Robles; Javier Martín Moreiras; Felipe Fernández-Vázquez; Ignacio J Amat-Santos; Joan Antoni Gómez-Hospital; Joan García-Picart; Bruno García Del Blanco; Ander Regueiro; Xavier Carrillo-Suárez; Helena Tizón; Mohsen Mohandes; Juan Casanova; Víctor Agudelo-Montañez; Juan Francisco Muñoz; Juan Franco; Roberto Del Castillo; Pablo Salinas; Jaime Elizaga; Fernando Sarnago; Santiago Jiménez-Valero; Fernando Rivero; Juan Francisco Oteo; Eduardo Alegría-Barrero; Ángel Sánchez-Recalde; Valeriano Ruíz; Eduardo Pinar; Eduardo Pinar; Ana Planas; Bernabé López Ledesma; Alberto Berenguer; Agustín Fernández-Cisnal; Pablo Aguar; Francisco Pomar; Miguel Jerez; Francisco Torres; Ricardo García; Araceli Frutos; Juan Miguel Ruíz Nodar; Koldobika García; Roberto Sáez; Alfonso Torres; Miren Tellería; Mario Sadaba; José Ramón López Mínguez; Juan Carlos Rama Merchán; Javier Portales; Ramiro Trillo; Guillermo Aldama; Saleta Fernández; Melisa Santás; María Pilar Portero Pérez Journal: Rev Esp Cardiol (Engl Ed) Date: 2020-09-08