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. 2022 Nov 8;80(19):1788-1798.
doi: 10.1016/j.jacc.2022.08.797.

Risk Factors for In-Hospital Cardiac Arrest in Patients With ST-Segment Elevation Myocardial Infarction

Wei Gong  1 , Yan Yan  1 , Xiao Wang  1 , Wen Zheng  1 , Sidney C Smith Jr  2 , Gregg C Fonarow  3 , Louise Morgan  4 , Jing Liu  5 , Dong Zhao  5 , Changsheng Ma  6 , Yaling Han  7 , Gilles Montalescot  8 , Shaoping Nie  9 ; CCC-ACS Investigators
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Free article

Risk Factors for In-Hospital Cardiac Arrest in Patients With ST-Segment Elevation Myocardial Infarction

Wei Gong et al. J Am Coll Cardiol. .
Free article

Abstract

Background: In-hospital cardiac arrest (IHCA) is one of the most deleterious complications of ST-segment elevation myocardial infarction (STEMI).

Objectives: We systematically analyzed the clinical characteristics of STEMI patients with IHCA, as well as predictors and treatments associated with risk of IHCA, using a nationwide database.

Methods: In the CCC-ACS (Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome) project (2014-2019), we stratified patients presenting with STEMI within 24 hours after symptom onset according to IHCA or no IHCA during the index hospitalization. We analyzed patients' clinical characteristics, mortality, and independent correlates of IHCA.

Results: Of 40,670 STEMI patients, 2.2% (95% CI: 2.1%-2.4%) experienced IHCA. Among IHCA patients, the in-hospital mortality was 53.0% (95% CI: 49.7%-56.3%). IHCA represents 55.0% (95% CI: 51.6%-58.4%) of inpatient deaths. Age ≥75 years, female, nonsmoker, prior diabetes mellitus, prior renal failure, out-of-hospital cardiac arrest, heart rate >100 beats/min, systolic blood pressure <90 mm Hg, and Killip IV were identified as predictors of IHCA. IHCA patients were less likely to receive β-blockers and ticagrelor during the first 24 hours after first medical contact and were less likely to undergo primary percutaneous coronary intervention. After adjustment, primary percutaneous coronary intervention (adjusted HR: 0.82; 95% CI: 0.71-0.95), β-blockers (adjusted HR: 0.63; 95% CI: 0.47-0.86), and ticagrelor (adjusted HR: 0.57; 95% CI: 0.42-0.76) were associated with a reduced risk of IHCA.

Conclusions: IHCA is rare in STEMI but is associated with high mortality. Multiple modifiable and unmodifiable factors are associated with its occurrence, suggesting that early intervention and rational drug treatment may improve its prognosis. (CCC Project- Acute Coronary Syndrome; NCT02306616).

Keywords: ST-segment elevation myocardial infarction; clinical outcomes; in-hospital cardiac arrest.

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Conflict of interest statement

Funding Support and Author Disclosures The CCC-ACS project is a collaborative study of the American Heart Association and the Chinese Society of Cardiology. The American Heart Association has been funded by Pfizer and AstraZeneca for quality improvement initiatives through an independent grant. Dr Gong was funded by grants from the National Natural Science Foundation of China (81970292, 81600213), Beijing Hospitals Authority Youth Program (QML20190603), and CS Optimizing Antithrombotic Research Fund (BJUHFCSOARF201901-08). Dr Yan was supported by grants from the National Natural Science Foundation of China (82100260) and Beijing Hospitals Authority Youth Program (QML20210605). Dr Ma has received honoraria from Bristol Myers Squibb, Pfizer, Johnson and Johnson, Boehringer Ingelheim, Bayer, and AstraZeneca for giving lectures. Dr Montalescot has received research grants to the institution or consulting/lecture fees from Abbott, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, Cell-Prothera, Europa, IRIS-Servier, Novartis, Medtronic, Merck Sharp & Dohme, Pfizer, Quantum Genomics, and Sanofi. Dr Nie was funded by Natural Science Foundation of Beijing, China (7191002), National Key Research and Development Program of China (2020YFC2004800), National Natural Science Foundation of China (81670222), the Capital Health Research and Development of Special Fund (2018-1-2061), and Beijing Municipal Administration of Hospitals' Ascent Plan (DFL20180601); and has received research grants to the institution from Boston Scientific, Abbott, Jiangsu Hengrui, China Resources Sanjiu, and Huadong Medicine. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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