P2670Predictors of survival to discharge in the acute myocardial infarction patients presenting with out-of-hospital cardiac arrest after return of spontaneous circulation

Abstract

Abstract Approximately 70% of survivals of out-of-hospital cardiac arrest (OHCA) have coronary artery disease, with acute vessel occlusion observed in 50%. Predictors of mortality in acute myocardial infarction (AMI) patients successfully resuscitated for OHCA were not well-determined. Between May, 2016 and July, 2018, 1428 consecutive patients with OHCA visited the emergency department of Far Eastern Memorial Hospital, New Taipei City, Taiwan. A total number of 117 patients with return-of-spontaneous-circulation (ROSC) were diagnosed of AMI, mostly confirmed by coronary angiography. The mean age was 60.0±13.6 (mean SD) with male gender 105/117. Endpoint was survival to discharge. The survival rate was 55.6%. Shockable rhythm (Ventricular tachycardia or fibrillation) during CPR (correlation coefficient, CC: 0.635; p<0.001), ST elevation myocardial infarction (CC: 0.550; p=0.003), sinus rhythm on first ECG (CC: 0.474; p=0.012) and higher HDL (CC: 0.471; p=0.0027) were associated better outcome (survival and neurological recovery). However, older age (CC: −0.564; p=0.002), ST depression on first ECG post resuscitation (CC: −0.481; p=0.011), hyperglycemia (CC: −0.419; p=0.030), higher HbA1C level (CC: −0.569; p=0.007), and hyperkalemia (CC: −0.612; p=0.001) were associated with worse outcome (Mortality). In conclusion, in the AMI patients presenting with OHCA after ROSC, unshockable rhythm during CPR, older age, non-sinus rhythm and ST segment depression on first ECG post resuscitation, hyperglycemia, higher HbA1C level, lower HDL level, and hyperkalemia were associated with higher hospital mortality.