Incidence, Mortality, and Outcome-Predictors of Sudden Cardiac Arrest Complicating Myocardial Infarction Prior to Hospital Admission
| Autor: | A. Allonneau, Virginie Pires, Christian Spaulding, Eloi Marijon, Nicole Karam, Xavier Jouven, Sophie Bataille, Mireille Mapouata, Yves Lambert, Jean-Michel Juliard, Benoît Simon, Hakim Benamer, Christophe Caussin, Philippe Garot, Muriel Tafflet, Jean-Philippe Empana, Aurélie Loyeau, Gaëlle Le Bail, Lionel Lamhaut, François Dupas, Thévy Boche, Frédéric Lapostolle |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Emergency Medical Services Paris Time Factors medicine.medical_treatment 030204 cardiovascular system & hematology Risk Assessment 03 medical and health sciences 0302 clinical medicine Patient Admission St elevation myocardial infarction Risk Factors Internal medicine medicine Humans cardiovascular diseases 030212 general & internal medicine Myocardial infarction Hospital Mortality Prospective Studies Aged business.industry Incidence (epidemiology) Incidence Percutaneous coronary intervention Sudden cardiac arrest Middle Aged medicine.disease Prognosis Patient Discharge Emergency Medical Technicians Death Sudden Cardiac Hospital admission Cardiology ST Elevation Myocardial Infarction Female medicine.symptom Cardiology and Cardiovascular Medicine business Inhospital mortality Out-of-Hospital Cardiac Arrest |
| Zdroj: | Circulation. Cardiovascular interventions. 12(1) |
| ISSN: | 1941-7632 |
| Popis: | 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 P 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. |
| Databáze: | OpenAIRE |
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