Clinical and Angiographic Features of Patients With Out-of-Hospital Cardiac Arrest and Acute Myocardial Infarction

J Am Coll Cardiol. 2020 Oct 27;76(17):1934-1943. doi: 10.1016/j.jacc.2020.08.057.

Abstract

Background: Sudden cardiac arrest is a serious complication of acute myocardial infarction (MI). Although in-hospital mortality from MI has decreased, the mortality of MI patients complicated with out-of-hospital cardiac arrest (OHCA) remains high. However, the features of acute MI patients with OHCA have not been well known.

Objectives: We sought to characterize the clinical and angiographic features of acute MI patients with OHCA comparing with those without OHCA.

Methods: We retrospectively analyzed 480 consecutive patients with acute MI undergoing percutaneous coronary intervention. Patients complicated with OHCA were compared with patients without OHCA.

Results: Of the patients, 141 (29%) were complicated with OHCA. Multivariate analysis revealed that age (odds ratio [OR]: 0.8; 95% confidence interval [CI]: 0.7 to 0.9 per 5 years; p < 0.001), estimated glomerular filtration rate (OR: 0.8; 95% CI: 0.7 to 0.8 per 10 ml/min/1.73 m2; p < 0.001), peak creatine kinase-myocardial band (OR: 1.3; 95% CI: 1.2 to 1.4 per 102 U/l; p < 0.001), calcium-channel antagonists use (OR: 0.4; 95% CI: 0.2 to 0.7; p = 0.002), the culprit lesion at the left main coronary artery (OR: 5.3; 95% CI: 1.9 to 15.1; p = 0.002), and the presence of chronic total occlusion (OR: 2.9; 95% CI: 1.5 to 5.7; p = 0.001) were significantly associated with OHCA.

Conclusions: Younger age, no use of calcium-channel antagonists, worse renal function, larger infarct size, culprit lesion in the left main coronary artery, and having chronic total occlusion were associated with OHCA.

Keywords: acute myocardial infarction; calcium-channel antagonist; chronic total occlusion; extracorporeal cardiopulmonary resuscitation; out-of-hospital cardiac arrest.

Publication types

  • Comparative Study

MeSH terms

  • Age Factors
  • Aged
  • Calcium Channel Blockers / therapeutic use
  • Coronary Angiography*
  • Coronary Occlusion / complications
  • Coronary Occlusion / diagnostic imaging
  • Creatine Kinase, MB Form / blood
  • Female
  • Glomerular Filtration Rate
  • Hospital Mortality
  • Humans
  • Japan / epidemiology
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Infarction / epidemiology*
  • Myocardial Infarction / therapy
  • Out-of-Hospital Cardiac Arrest / epidemiology*
  • Out-of-Hospital Cardiac Arrest / therapy
  • Percutaneous Coronary Intervention
  • Retrospective Studies
  • Risk Factors
  • Tachycardia, Ventricular / epidemiology

Substances

  • Calcium Channel Blockers
  • Creatine Kinase, MB Form