Clinical Characteristics and Outcomes of STEMI Patients With Cardiogenic Shock and Cardiac Arrest

Autor: Timothy D. Henry, Mohamed Omer, Nicholas Burke, Michael Mooney, Emmanouil S. Brilakis, Ivan Chavez, Michael Megaly, Peter Eckman, Scott W. Sharkey, Yale Wang, Christian W. Schmidt, Jay H. Traverse, Ross Garberich, K. Hryniewicz, Mario Gössl, Santiago Garcia, Jason T. Henry, Paul Sorajja, Jeffrey Tyler
Rok vydání: 2020
Předmět:
Male
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Electric Countershock
Shock
Cardiogenic
Hospital mortality
030204 cardiovascular system & hematology
Risk Assessment
03 medical and health sciences
Percutaneous Coronary Intervention
0302 clinical medicine
Heart Rate
Risk Factors
Internal medicine
Humans
Medicine
In patient
Hospital Mortality
Registries
cardiovascular diseases
030212 general & internal medicine
Myocardial infarction
Symptom onset
Aged
Retrospective Studies
Aged
80 and over
Bundle branch block
business.industry
Cardiogenic shock
Percutaneous coronary intervention
Arrhythmias
Cardiac
Middle Aged
medicine.disease
Heart Arrest
Treatment Outcome
surgical procedures
operative
Conventional PCI
Cardiology
ST Elevation Myocardial Infarction
Female
Cardiology and Cardiovascular Medicine
business
Zdroj: JACC: Cardiovascular Interventions. 13:1211-1219
ISSN: 1936-8798
DOI: 10.1016/j.jcin.2020.04.004
Popis: 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).Patients with STEMI complicated by CS or CA are underrepresented in STEMI registries.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.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).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.
Databáze: OpenAIRE
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