SPC365

Resuscitated cardiac arrest in patients with acute myocardial infarction is associated with increased infarct size and worse outcomes

Session: Comunicações Orais (Sessão 2) - DAC e Cuidados Intensivos 1: Síndromes Coronárias Agudas
Speaker: João Presume

Congress: CPC 2022
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.6 Acute Coronary Syndromes - Clinical
Session Type: Comunicações Orais
FP Number: ---
Authors: João Presume; Daniel Gomes; Francisco Albuquerque; Mariana Paiva; Christopher Strong; António Tralhão; Carlos Aguiar; Marisa Trabulo; Regina Ribeiras; Manuel Almeida; Jorge Ferreira; Miguel Mendes

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><u><span style="font-family:AppleSystemUIFontBold">Background:</span></u></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:AppleSystemUIFont">Resuscitated cardiac arrest (RCA) during the acute ischaemic phase is a relatively frequent but often undervalued complication of acute myocardial infarction (AMI). The aim of this study was to evaluate the clinical and prognostic impact of aborted cardiac arrest in AMI patients and investigate its correlation with infarct size. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><u><span style="font-family:AppleSystemUIFontBold">Methods:</span></u></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:AppleSystemUIFont">We conducted a single-centre retrospective study enrolling consecutive patients admitted for AMI, from January 2016 to December 2018. RCA was defined as the need for advanced life support measures and defibrillation, either out-of-hospital or in-hospital, up until culprit vessel revascularisation. Infarct size was estimated using peak serum troponin T, impact on left ventricular ejection fraction (LVEF &le; 50%) and echocardiographic wall motion index (WMI). Clinical outcomes included cardiogenic shock (SCAI C or more), need for mechanical circulatory support (MCS), major bleeding events (BARC &ge;3) during in-hospital phase and all-cause mortality during follow-up.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><u><span style="font-family:AppleSystemUIFontBold">Results:</span></u></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:AppleSystemUIFont">A total of 571 patients were included (65 &plusmn; 13 years old, 72% male). Overall, 237 had anterior STEMI, 39 patients (6,8%) suffered RCA (21 out of hospital), 60 progressed into cardiogenic shock throughout the hospitalisation, 7 needed MCS, and 52 had BARC &ge;3 bleeding. During a mean follow-up of 32 months, 96 patients died. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:AppleSystemUIFont">RCA was significantly associated with higher peak serum troponin T (4802 [1950;9420] vs 2659 [555;6708] ng/L &ndash; p=0.004), higher proportion of patients with reduced or mildly reduced LVEF (60% vs. 36,5%, p=0.018) and higher WMI (1.7 [1.4;2.3] vs. 1.5 [1.2;1.8], p=0.016). Moreover, RCA was also associated with higher risk of cardiogenic shock occurrence (64.1% vs. 6.6% - p&lt;0.001 - OR 25.357 (12.115-53.073)), higher need for MCS (7.9% vs 0.8% - p &lt;0.001 - OR 11.271 (2.427-52.343)) and higher incidence of BARC &ge;3 bleeding events (28.2% vs. 8.4% - p &lt;0.001 - OR 4.705 (2.185-10.128)) &ndash; Table 1.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:AppleSystemUIFont">On univariate Cox regression, RCA showed significant association with all cause death, which remained highly significant after multivariable adjustment (OR 2.431 (1.181;5.002); p=0.016).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><u><span style="font-family:AppleSystemUIFontBold">Conclusion:</span></u></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:AppleSystemUIFont">The occurrence of aborted cardiac arrest in patients with AMI was associated with increased morbidity and mortality. This may be driven by a larger area of arrhythmia prone ischemic myocardium.</span></span></span></p>