Factors predicting cardiac arrest in acute coronary syndrome patients under 50: A state-wide angiographic and forensic evaluation of outcomes.

Acute Coronary Syndrome / complications Aftercare Humans Myocardial Infarction / complications Out-of-Hospital Cardiac Arrest / complications Patient Discharge Percutaneous Coronary Intervention ST Elevation Myocardial Infarction Treatment Outcome
Cardiac arrest Forensic medicine Mortality Myocardial infarction Percutaneous coronary intervention

Journal

Resuscitation
ISSN: 1873-1570
Titre abrégé: Resuscitation
Pays: Ireland
ID NLM: 0332173

Informations de publication

Date de publication:
10 2022
Historique:
received: 07 07 2022
revised: 16 08 2022
accepted: 21 08 2022
pubmed: 29 8 2022
medline: 5 10 2022
entrez: 28 8 2022
Statut: ppublish

Résumé

An uncertain proportion of patients with acute coronary syndrome (ACS) also experience out-of-hospital cardiac arrest (OHCA). Predictors of OHCA in ACS remain unclear and vulnerable to selection bias as pre-hospital deceased patients are usually not included. Data on patients aged 18-50 years from a percutaneous coronary intervention (PCI) and OHCA registry were combined to identify all patients experiencing OHCA due to ACS (not including those managed medically or who proceeded to cardiac surgery). Clinical, angiographic and forensic details were collated. In-hospital and post-discharge outcomes were compared between OHCA survivors and non-OHCA ACS patients. OHCA occurred in 6.0% of ACS patients transported to hospital and 10.0% of all ACS patients. Clinical predictors were non-diabetic status (p = 0.015), non-obesity (p = 0.004), ST-elevation myocardial infarction (p < 0.0001) and left main (p < 0.0002) or left anterior descending (LAD) coronary artery (p < 0.0001) as culprit vessel. OHCA patients had poorer in-hospital clinical outcomes, including longer length of stay and higher pre-procedural intubation, cardiogenic shock, major adverse cardiovascular events, bleeding, and mortality (p < 0.0001 for all). At 30 days, OHCA survivors had equivalent cardiac function and return to premorbid independence but higher rates of anxiety/depression (p = 0.029). OHCA complicates approximately 10% of ACS in the young. Predictors of OHCA are being non-diabetic, non-obese, having a STEMI presentation, and left main or LAD coronary culprit lesion. For OHCA patients surviving to PCI, higher rates of in-hospital complications are observed. Despite this, recovery of pre-morbid physical and cardiac function is equivalent to non-OHCA patients, apart from higher rates of anxiety/depression.

Sections du résumé

BACKGROUND
An uncertain proportion of patients with acute coronary syndrome (ACS) also experience out-of-hospital cardiac arrest (OHCA). Predictors of OHCA in ACS remain unclear and vulnerable to selection bias as pre-hospital deceased patients are usually not included.
METHODS
Data on patients aged 18-50 years from a percutaneous coronary intervention (PCI) and OHCA registry were combined to identify all patients experiencing OHCA due to ACS (not including those managed medically or who proceeded to cardiac surgery). Clinical, angiographic and forensic details were collated. In-hospital and post-discharge outcomes were compared between OHCA survivors and non-OHCA ACS patients.
RESULTS
OHCA occurred in 6.0% of ACS patients transported to hospital and 10.0% of all ACS patients. Clinical predictors were non-diabetic status (p = 0.015), non-obesity (p = 0.004), ST-elevation myocardial infarction (p < 0.0001) and left main (p < 0.0002) or left anterior descending (LAD) coronary artery (p < 0.0001) as culprit vessel. OHCA patients had poorer in-hospital clinical outcomes, including longer length of stay and higher pre-procedural intubation, cardiogenic shock, major adverse cardiovascular events, bleeding, and mortality (p < 0.0001 for all). At 30 days, OHCA survivors had equivalent cardiac function and return to premorbid independence but higher rates of anxiety/depression (p = 0.029).
CONCLUSION
OHCA complicates approximately 10% of ACS in the young. Predictors of OHCA are being non-diabetic, non-obese, having a STEMI presentation, and left main or LAD coronary culprit lesion. For OHCA patients surviving to PCI, higher rates of in-hospital complications are observed. Despite this, recovery of pre-morbid physical and cardiac function is equivalent to non-OHCA patients, apart from higher rates of anxiety/depression.

Identifiants

DOI: 10.1016/j.resuscitation.2022.08.016 PMID: 36031075
pubmed: 36031075
pii: S0300-9572(22)00651-7
doi: 10.1016/j.resuscitation.2022.08.016
pii:
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

124-130

Investigateurs

Dominica Zentner (D)
Paul James (P)
Sarah Parsons (S)
Natalie Morgan (N)
Tina Thompson (T)
Vanessa Connell (V)

Informations de copyright

Crown Copyright © 2022. Published by Elsevier B.V. All rights reserved.

Auteurs

Elizabeth D Paratz (ED)

Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia; Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia; St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC 3065, Australia. Electronic address: elizabeth.paratz@baker.edu.au.

Alexander van Heusden (A)

Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia.

Karen Smith (K)

Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC 3108, Australia; Department of Paramedicine, Monash University, Melbourne, VIC, Australia; Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia.

Angela Brennan (A)

Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia.

Diem Dinh (D)

Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia.

Jocasta Ball (J)

Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia.

Jeff Lefkovits (J)

Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia.

David M Kaye (DM)

Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia.

Stephen J Nicholls (SJ)

Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia.

Andreas Pflaumer (A)

Royal Children's Hospital, 50 Flemington Rd, Parkville, Melbourne, VIC 3052, Australia; Department of Paediatrics, Melbourne University, Parkville, VIC 3010, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Rd, Parkville, VIC 3052, Australia.

Andre La Gerche (A)

Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia; Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia; St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC 3065, Australia.

Dion Stub (D)

Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia; Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia; Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC 3108, Australia; Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia.

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Classifications MeSH

questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Ischémie myocardique › Syndrome coronarien aigu › Factors predicting cardiac arrest in acute...
questionsmedicales.fr › Administration des services de santé › Gestion des soins aux patients › Services de santé polyvalents › Soins de santé primaires › Continuité des soins › Post-cure › Factors predicting cardiac arrest in acute...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Factors predicting cardiac arrest in acute...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Nécrose › Infarctus › Infarctus du myocarde › Factors predicting cardiac arrest in acute...
questionsmedicales.fr › Maladies cardiovasculaires › Cardiopathies › Arrêt cardiaque › Arrêt cardiaque hors hôpital › Factors predicting cardiac arrest in acute...
questionsmedicales.fr › Administration des services de santé › Gestion des soins aux patients › Services de santé polyvalents › Soins de santé primaires › Continuité des soins › Sortie du patient › Factors predicting cardiac arrest in acute...
questionsmedicales.fr › Procédures de chirurgie opératoire › Interventions chirurgicales mini-invasives › Procédures endovasculaires › Intervention coronarienne percutanée › Factors predicting cardiac arrest in acute...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Nécrose › Infarctus › Infarctus du myocarde › Infarctus du myocarde avec sus-décalage du segment ST › Factors predicting cardiac arrest in acute...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Factors predicting cardiac arrest in acute...