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Features of Patients With Out-of-Hospital Cardiac Arrest and Acute MI
Quick Takes
- Frequent and early use of percutaneous cardiopulmonary support systems in all OHCA patients allowed for inclusion and study of patients who otherwise would not have made it to coronary angiography.
- Younger age, no use of calcium channel blocker, larger infarct, renal failure, presence of chronic total occlusion, and left main disease were predictors of acute MI patients with OHCA compared to patients with MI without arrest.
Study Questions:
What are clinical and angiographic characteristics of patients with acute myocardial infarction (MI) and out-of-hospital cardiac arrest (OHCA)?
Methods:
This was a retrospective analysis of 480 consecutive patients with acute MI undergoing percutaneous coronary intervention. Patients complicated with OHCA were compared with patients without OHCA. This study is unique in aggressive and early use of percutaneous cardiopulmonary support system allowing for a larger group of patients with OHCA to be assessed with coronary angiography.
Results:
Of the patients, 141 (29%) were complicated with OHCA. Multivariate analysis revealed that age (odds ratio [OR], 0.8; 95% confidence interval [CI], 0.7-0.9 per 5 years; p < 0.001), estimated glomerular filtration rate (OR, 0.8; 95% CI, 0.7-0.8 per 10 ml/min/1.73 m2; p < 0.001), peak creatine kinase-myocardial band (OR, 1.3; 95% CI, 1.2-1.4 per 102 U/L; p < 0.001), calcium-channel antagonists use (OR, 0.4; 95% CI, 0.2-0.7; p = 0.002), the culprit lesion at the left main coronary artery (OR, 5.3; 95% CI, 1.9-15.1; p = 0.002), and the presence of chronic total occlusion (OR, 2.9; 95% CI, 1.5-5.7; p = 0.001) were significantly associated with OHCA.
Conclusions:
Younger age, no use of calcium-channel antagonists, worse renal function, larger infarct size, culprit lesion in the left main coronary artery, and having chronic total occlusion were associated with OHCA.
Perspective:
The current study is from hospital systems in Japan where percutaneous cardiopulmonary support systems (venoarterial extracorporeal membrane oxygenation) are instituted early and frequently, which allowed for patients who might have otherwise died prior to angiography to be included in the analysis. Of the predictors defined, use of calcium channel blockers being protective suggests that coronary spasm may have played a role among the cohort studied. In-hospital mortality for OHCA survivors in this inclusive cohort was approximately 60%.
Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Interventions and ACS, Interventions and Imaging, Angiography, Nuclear Imaging
Keywords: Acute Coronary Syndrome, Arrhythmias, Cardiac, Calcium Channel Blockers, Coronary Angiography, Coronary Occlusion, Creatine Kinase, MB Form, Extracorporeal Membrane Oxygenation, Glomerular Filtration Rate, Heart Arrest, Hospital Mortality, Myocardial Infarction, Out-of-Hospital Cardiac Arrest, Percutaneous Coronary Intervention, Renal Insufficiency
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