ASSOCIATION OF LEFT ANTERIOR CORONARY ARTERY INVOLVEMENT ON CLINICAL OUTCOMES AMONG STEMI PATIENTS PRESENTING WITH AND WITHOUT OUT-OF-HOSPITAL CARDIAC ARREST

Abstract

Acute ST elevation myocardial infarction (STEMI) complicated by out-of-hospital cardiac arrest (OHCA) is associated with greater in-hospital mortality compared to STEMI patients without cardiac arrest. However, there has been no prior attempt to discern if there is an independent association of culprit coronary artery involvement with outcomes of STEMI patients with and without OHCA. This study aimed to describe such an independent association. We identified all 1020 patients within the Vancouver Coastal Health Authority (VHCA) who presented with an acute STEMI and who underwent primary percutaneous coronary intervention (pPCI) between June 26, 2007 and March 31, 2016. Among these, there were 91 patients with and 929 without a preceding OHCA. Logistic regression was used to examine the impact of ischemic territory and OHCA on mortality and other outcomes. STEMI patients with OHCA had more in-hospital-cardiac arrest (43.3% vs 8.3% p < 0.001), heart failure (50.5% vs 11.3% p < 0.001), cardiogenic shock (49.5% vs 5.7% p < 0.001) and mortality (35.2% vs 3.3% p < 0.001) compared to STEMI patients without OHCA. Left anterior coronary artery (LACA) involvement was identified in 57.1% of STEMI patients with OHCA and in 47.7% of STEMI patients without OHCA (p=0.085). Among non-OHCA patients, LACA involvement was associated with increased heart failure (18.1% vs 5.2% p < 0.001), in-hospital cardiac arrest (10.7% vs 6.2% p < 0.014), cardiogenic shock (8.4% vs 3.3% p < 0.001) and mortality (5.2% vs 1.3% p=0.003) compared to no LACA involvement, but not in OHCA patients. Logistic regression demonstrated that LACA involvement and OHCA were both independently associated with increased in-hospital mortality, but there was no significant association between the presence of OHCA and LACA involvement (Figure 1). Compared to STEMI patients without OHCA, those with OHCA experienced worse in-hospital outcomes. Similarly, compared to non-ACA involvement, ACA involvement was also associated with worse in-hospital outcomes, but only among STEMI patients without OHCA. This data suggests that ACA involvement in STEMI confers a worse prognosis among STEMI patients without OHCA, and suggests that OHCA patients have other high risk features that drive their poor outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)