TY - JOUR
T1 - Clinical Characteristics and Outcomes of STEMI Patients With Cardiogenic Shock and Cardiac Arrest
AU - Omer, Mohamed A.
AU - Tyler, Jeffrey M.
AU - Henry, Timothy D.
AU - Garberich, Ross
AU - Sharkey, Scott W.
AU - Schmidt, Christian W.
AU - Henry, Jason T.
AU - Eckman, Peter
AU - Megaly, Michael
AU - Brilakis, Emmanouil S.
AU - Chavez, Ivan
AU - Burke, Nicholas
AU - Gössl, Mario
AU - Mooney, Michael
AU - Sorajja, Paul
AU - Traverse, Jay H.
AU - Wang, Yale
AU - Hryniewicz, Katarzyna
AU - Garcia, Santiago
N1 - Funding Information:
The Regional STEMI program is supported by the Minneapolis Heart Institute Foundation and Allina Health. Dr. Eckman has served as a consultant for Abbott Vascular and Medtronic. Dr. Brilkais has served as a consultant for and received speaker honoraria from Biotronik, CSI, Cardiovascular Innovations, GE Healthcare, Infraredx, Abbott Vascular, Asahi, Boston Scientific, Elsevier, Somahlution, St. Jude Medical, Medtronic, Siemens, and Terumo; has received consulting honoraria from the American Heart Association (as the associate editor of Circulation); has received research support from Infraredx, Regeneron, Siemens, and Boston Scientific; and owns equity in MHI Ventures. Dr. Burke has served as a speaker for Opsens Medical; has served as a consultant for Abbott Vascular; and owns equity in Egg Medical and MHI Ventures. Dr. Gössl has served as a consultant for Abbott Vascular and has received research grant support from Edwards Lifesciences. Dr. Sorajja has received research grant support from Edwards Lifesciences, Boston Scientific, and Abbott Vascular; has served as a consultant for Edwards Lifesciences, Boston Scientific, Admedus, Gore, and Cardionomics, and Abbott Vascular; has served as a speaker for Edwards Lifesciences, Boston Scientific, and Abbott Vascular; and owns equity in Admedus. Dr. Garcia has served as a consultant for Edwards Lifesciences, Medtronic, and Abbott Vascular; and has received research grant support from Boston Scientific and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Funding Information:
The Regional STEMI program is supported by the Minneapolis Heart Institute Foundation and Allina Health. Dr. Eckman has served as a consultant for Abbott Vascular and Medtronic. Dr. Brilkais has served as a consultant for and received speaker honoraria from Biotronik, CSI, Cardiovascular Innovations, GE Healthcare, Infraredx, Abbott Vascular, Asahi, Boston Scientific, Elsevier, Somahlution, St. Jude Medical, Medtronic, Siemens, and Terumo; has received consulting honoraria from the American Heart Association (as the associate editor of Circulation); has received research support from Infraredx, Regeneron, Siemens, and Boston Scientific; and owns equity in MHI Ventures. Dr. Burke has served as a speaker for Opsens Medical; has served as a consultant for Abbott Vascular; and owns equity in Egg Medical and MHI Ventures. Dr. Gössl has served as a consultant for Abbott Vascular and has received research grant support from Edwards Lifesciences. Dr. Sorajja has received research grant support from Edwards Lifesciences, Boston Scientific, and Abbott Vascular; has served as a consultant for Edwards Lifesciences, Boston Scientific, Admedus, Gore, and Cardionomics, and Abbott Vascular; has served as a speaker for Edwards Lifesciences, Boston Scientific, and Abbott Vascular; and owns equity in Admedus. Dr. Garcia has served as a consultant for Edwards Lifesciences, Medtronic, and Abbott Vascular; and has received research grant support from Boston Scientific and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2020 American College of Cardiology Foundation
PY - 2020/5/25
Y1 - 2020/5/25
N2 - Objectives: This study sought to compare the clinical characteristics and long-term outcomes of patients with ST-segment elevation myocardial infarction (STEMI) with and without cardiogenic shock (CS) or cardiac arrest (CA) before percutaneous coronary intervention (PCI). Background: Patients with STEMI complicated by CS or CA are underrepresented in STEMI registries. Methods: Consecutive patients with STEMI or new left bundle branch block within 24 h of symptom onset were included in a regional STEMI program comprising a PCI center (Minneapolis Heart Institute at Abbott Northwestern Hospital), 11 hospitals <60 miles from PCI center (zone 1), and 19 hospitals 60 to 210 miles from PCI center (zone 2). No patients were excluded. Patients were stratified based on the presence (+) or absence (–) of CS or CA before PCI. Patients with CA were further classified based on initial rhythm. Primary outcomes were in-hospital and 5-year mortality. Results: Between March 2003 and December 2014, 4,511 STEMI patients were included in the regional program, including 398 (9%) with CS and 499 (11%) with CA. Hospital mortality was: CS+ and CA+, 44%; CS+ and CA–, 23%; CS– and CA+, 19%; and CS– and CA–, 2% (p < 0.001). The 5-year survival probability for CS+ and CA+ patients was 0.69 (95% confidence interval: 0.61 to 0.76) and 0.89 (95% confidence interval: 0.84 to 0.93), respectively (p < 0.01). Compared with patients with shockable rhythms, CA patients with nonshockable rhythms had significantly lower odds of survival at hospital discharge and at 5 years (both p < 0.001). Conclusions: The combination of CS and CA significantly increases short-term mortality in patients with STEMI. After 5 years of follow-up, CS patients remained at high risk of fatal events, whereas the prognosis of CA patients was determined by initial rhythm at presentation.
AB - Objectives: This study sought to compare the clinical characteristics and long-term outcomes of patients with ST-segment elevation myocardial infarction (STEMI) with and without cardiogenic shock (CS) or cardiac arrest (CA) before percutaneous coronary intervention (PCI). Background: Patients with STEMI complicated by CS or CA are underrepresented in STEMI registries. Methods: Consecutive patients with STEMI or new left bundle branch block within 24 h of symptom onset were included in a regional STEMI program comprising a PCI center (Minneapolis Heart Institute at Abbott Northwestern Hospital), 11 hospitals <60 miles from PCI center (zone 1), and 19 hospitals 60 to 210 miles from PCI center (zone 2). No patients were excluded. Patients were stratified based on the presence (+) or absence (–) of CS or CA before PCI. Patients with CA were further classified based on initial rhythm. Primary outcomes were in-hospital and 5-year mortality. Results: Between March 2003 and December 2014, 4,511 STEMI patients were included in the regional program, including 398 (9%) with CS and 499 (11%) with CA. Hospital mortality was: CS+ and CA+, 44%; CS+ and CA–, 23%; CS– and CA+, 19%; and CS– and CA–, 2% (p < 0.001). The 5-year survival probability for CS+ and CA+ patients was 0.69 (95% confidence interval: 0.61 to 0.76) and 0.89 (95% confidence interval: 0.84 to 0.93), respectively (p < 0.01). Compared with patients with shockable rhythms, CA patients with nonshockable rhythms had significantly lower odds of survival at hospital discharge and at 5 years (both p < 0.001). Conclusions: The combination of CS and CA significantly increases short-term mortality in patients with STEMI. After 5 years of follow-up, CS patients remained at high risk of fatal events, whereas the prognosis of CA patients was determined by initial rhythm at presentation.
KW - ST-segment elevation myocardial infarction
KW - cardiac arrest
KW - cardiogenic shock
UR - http://www.scopus.com/inward/record.url?scp=85084366882&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85084366882&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2020.04.004
DO - 10.1016/j.jcin.2020.04.004
M3 - Article
C2 - 32438992
AN - SCOPUS:85084366882
SN - 1936-8798
VL - 13
SP - 1211
EP - 1219
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 10
ER -