OBJECTIVES: This study sought to compare the clinical characteristics and long-term outcomes of patients with ST-segment elevation myocardial infarction (STEMI) with and without cardiogenic shock (CS) or cardiac arrest (CA) before percutaneous coronary intervention (PCI). BACKGROUND: Patients with STEMI complicated by CS or CA are underrepresented in STEMI registries. METHODS: Consecutive patients with STEMI or new left bundle branch block within 24 h of symptom onset were included in a regional STEMI program comprising a PCI center (Minneapolis Heart Institute at Abbott Northwestern Hospital), 11 hospitals <60 miles from PCI center (zone 1), and 19 hospitals 60 to 210 miles from PCI center (zone 2). No patients were excluded. Patients were stratified based on the presence (+) or absence (-) of CS or CA before PCI. Patients with CA were further classified based on initial rhythm. Primary outcomes were in-hospital and 5-year mortality. RESULTS: Between March 2003 and December 2014, 4,511 STEMI patients were included in the regional program, including 398 (9%) with CS and 499 (11%) with CA. Hospital mortality was: CS+ and CA+, 44%; CS+ and CA-, 23%; CS- and CA+, 19%; and CS- and CA-, 2% (p < 0.001). The 5-year survival probability for CS+ and CA+ patients was 0.69 (95% confidence interval: 0.61 to 0.76) and 0.89 (95% confidence interval: 0.84 to 0.93), respectively (p < 0.01). Compared with patients with shockable rhythms, CA patients with nonshockable rhythms had significantly lower odds of survival at hospital discharge and at 5 years (both p < 0.001). CONCLUSIONS: The combination of CS and CA significantly increases short-term mortality in patients with STEMI. After 5 years of follow-up, CS patients remained at high risk of fatal events, whereas the prognosis of CA patients was determined by initial rhythm at presentation.
OBJECTIVES: This study sought to compare the clinical characteristics and long-term outcomes of patients with ST-segment elevation myocardial infarction (STEMI) with and without cardiogenic shock (CS) or cardiac arrest (CA) before percutaneous coronary intervention (PCI). BACKGROUND:Patients with STEMI complicated by CS or CA are underrepresented in STEMI registries. METHODS: Consecutive patients with STEMI or new left bundle branch block within 24 h of symptom onset were included in a regional STEMI program comprising a PCI center (Minneapolis Heart Institute at Abbott Northwestern Hospital), 11 hospitals <60 miles from PCI center (zone 1), and 19 hospitals 60 to 210 miles from PCI center (zone 2). No patients were excluded. Patients were stratified based on the presence (+) or absence (-) of CS or CA before PCI. Patients with CA were further classified based on initial rhythm. Primary outcomes were in-hospital and 5-year mortality. RESULTS: Between March 2003 and December 2014, 4,511 STEMI patients were included in the regional program, including 398 (9%) with CS and 499 (11%) with CA. Hospital mortality was: CS+ and CA+, 44%; CS+ and CA-, 23%; CS- and CA+, 19%; and CS- and CA-, 2% (p < 0.001). The 5-year survival probability for CS+ and CA+ patients was 0.69 (95% confidence interval: 0.61 to 0.76) and 0.89 (95% confidence interval: 0.84 to 0.93), respectively (p < 0.01). Compared with patients with shockable rhythms, CA patients with nonshockable rhythms had significantly lower odds of survival at hospital discharge and at 5 years (both p < 0.001). CONCLUSIONS: The combination of CS and CA significantly increases short-term mortality in patients with STEMI. After 5 years of follow-up, CS patients remained at high risk of fatal events, whereas the prognosis of CA patients was determined by initial rhythm at presentation.
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: Saraschandra Vallabhajosyula; Stephanie R Payne; Jacob C Jentzer; Lindsey R Sangaralingham; Kianoush Kashani; Nilay D Shah; Abhiram Prasad; Shannon M Dunlay Journal: Mayo Clin Proc Innov Qual Outcomes Date: 2021-02-08
Authors: Jingwei Duan; Qiangrong Zhai; Yuanchao Shi; Hongxia Ge; Kang Zheng; Lanfang Du; Baomin Duan; Jie Yu; Qingbian Ma Journal: Front Cardiovasc Med Date: 2022-01-07
Authors: Jacob C Jentzer; Anusha G Bhat; Sri Harsha Patlolla; Shashank S Sinha; P Elliott Miller; Patrick R Lawler; Sean van Diepen; Ashish K Khanna; David X Zhao; Saraschandra Vallabhajosyula Journal: Crit Care Explor Date: 2022-02-04
Authors: Brian A Bergmark; Njambi Mathenge; Piera A Merlini; Marilyn B Lawrence-Wright; Robert P Giugliano Journal: Lancet Date: 2022-04-02 Impact factor: 79.321
Authors: Anirudh Kumar; Leon Zhou; Chetan P Huded; Laurie Ann Moennich; Venu Menon; Rishi Puri; Grant W Reed; Ravi Nair; Jaikirshan J Khatri; Amar Krishnaswamy; A Michael Lincoff; Stephen G Ellis; Khaled M Ziada; Samir R Kapadia; Umesh N Khot Journal: Resusc Plus Date: 2021-07-15