Characteristic and outcome in patients with st-evaluation myocardial infarction an out-of hospital reanimation insight from the national amis plus registry 1997-2011

Abstract

Background: Cardiac arrest is one of the most life-threatening complications of ST-Elevation Myocardial Infarction (STEMI). Aim of the study was to identify potential treatable factors jeopardizing the outcome out of hospital resuscitated STEMI patients. Methods: All acute STEMI enrolled in the AMIS PLUS registry between January 1, 1997 and December 31, 2011 were analyzed. Patients were divided into those who had experienced Out-of Hospital Cardiac Arrest (OHCA) and those who did not. OHCA was defined as cardiac arrest requiring resuscitation procedures (chest compression, defibrillation, cardioversion), as defined by the European Resuscitation Council. Successful resuscitation was required in order to be included in this study. The primary outcome was in-hospital mortality. Secondary outcome measures were the rates of in-hospital major adverse cardiac or cerebrovascular events. Results: Between 1997 and 2011, a total of 21,401 patients with STEMI were included in the AMISplus registry. 939 of 20,773 patients (4.5%) with complete data sets had OHCA. There mortality was 31.1% vs. 6.7% (p<0.001). STEMI patients with OHCA were younger, more often males and smokers. The extension of coronary artery disease and comorbidities were similar between groups. More patients with OHCA were in cardiogenic shock and needed catecholamines and/or mechanical ventilation. In hospital CPR was more frequently in OHCA patients. A primary PCI was performed in 55.9% controls and 57.6% OHCA patients (p = 0.31). At hospital discharge less patients with OHCA received aspirin, statins, beta blockers and ACE Inhibitors/AT Antagonists. Since 2009 therapeutic hypothermia was recorded and performed in 55 (46%) out of 119 OHCA patients. In the logistic regression analyses, the OR for mortality for patients who had CPR prior to admission was, unadjusted, 6.3 (95% CI 5.4 to 7.32; p<0.001); and adjusted for age and gender it was 10.18 ((95% CI 8.6 to 12.04; p<0.001). Conclusion: The mortality of STEMI patients with out-of-hospital cardiac arrest is high. Appropriate management of cardiogenic shock and therapeutic hypothermia are key to reduce mortality in these patients.