Prognostic implication of out-of-hospital cardiac arrest in patients with cardiogenic shock and acute myocardial infarction

TY - JOUR

T1 - Prognostic implication of out-of-hospital cardiac arrest in patients with cardiogenic shock and acute myocardial infarction

AU - Ostenfeld, Sarah

AU - Lindholm, Matias Greve

AU - Kjaergaard, Jesper

AU - Bro-Jeppesen, John

AU - Møller, Jacob Eifer

AU - Wanscher, Michael

AU - Hassager, Christian

N1 - Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

PY - 2015/2/1

Y1 - 2015/2/1

N2 - Objectives: To compare outcome in patients with acute myocardial infarction (MI) and cardiogenic shock (CS) presenting with and without out-of-hospital cardiac arrest (OHCA). Background: Despite general improvement in outcome after acute MI, CS remains a leading cause of death in acute MI patients with a high 30-day mortality rate. OHCA on top of cardiogenic shock may further increase mortality in these patients resulting in premature withdrawal of supportive therapy, but this is not known. Methods and results: In a retrospective study from 2008 to 2013, 248 consecutive patients admitted alive to a tertiary centre with the diagnosis of CS and acute MI were enrolled, 118 (48%) presented with OHCA and 130 (52%) without (non-OHCA patients). Mean lactate level at admission was significantly higher in OHCA patients compared with non-OCHA patients (9. mmol/l (SD 6) vs. 6. mmol/l (SD 4) p<. 0.0001). Co-morbidities were more prevalent in the non-OHCA group. By univariate analysis age (Hazard ratio (HR) = 1.02 [CI 1.00-1.03], p= 0.01) and lactate at admission (HR = 1.06 [CI 1.03-1.09], p< 0.001), but not OHCA (HR = 1.1 [CI 0.8-1.4], p= NS) was associated with mortality. In multivariate analysis, only age (HR = 1.02 [CI 1.01-1.04], p= 0.003) and lactate level at admission (HR = 1.06 [1.03-1.09], p< 0.001) were independent predictors of mortality. One-week mortality was 63% in the OHCA group and 56% in the non-OHCA group, p= NS. Conclusion: OHCA is not an independent predictor of mortality in patients with acute MI complicated by cardiogenic shock. This should encourage active intensive treatment of CS patients regardless of OHCA.

AB - Objectives: To compare outcome in patients with acute myocardial infarction (MI) and cardiogenic shock (CS) presenting with and without out-of-hospital cardiac arrest (OHCA). Background: Despite general improvement in outcome after acute MI, CS remains a leading cause of death in acute MI patients with a high 30-day mortality rate. OHCA on top of cardiogenic shock may further increase mortality in these patients resulting in premature withdrawal of supportive therapy, but this is not known. Methods and results: In a retrospective study from 2008 to 2013, 248 consecutive patients admitted alive to a tertiary centre with the diagnosis of CS and acute MI were enrolled, 118 (48%) presented with OHCA and 130 (52%) without (non-OHCA patients). Mean lactate level at admission was significantly higher in OHCA patients compared with non-OCHA patients (9. mmol/l (SD 6) vs. 6. mmol/l (SD 4) p<. 0.0001). Co-morbidities were more prevalent in the non-OHCA group. By univariate analysis age (Hazard ratio (HR) = 1.02 [CI 1.00-1.03], p= 0.01) and lactate at admission (HR = 1.06 [CI 1.03-1.09], p< 0.001), but not OHCA (HR = 1.1 [CI 0.8-1.4], p= NS) was associated with mortality. In multivariate analysis, only age (HR = 1.02 [CI 1.01-1.04], p= 0.003) and lactate level at admission (HR = 1.06 [1.03-1.09], p< 0.001) were independent predictors of mortality. One-week mortality was 63% in the OHCA group and 56% in the non-OHCA group, p= NS. Conclusion: OHCA is not an independent predictor of mortality in patients with acute MI complicated by cardiogenic shock. This should encourage active intensive treatment of CS patients regardless of OHCA.

KW - Age Factors

KW - Aged

KW - Comorbidity

KW - Denmark

KW - Female

KW - Humans

KW - Lactic Acid

KW - Male

KW - Middle Aged

KW - Myocardial Infarction

KW - Out-of-Hospital Cardiac Arrest

KW - Outcome Assessment (Health Care)

KW - Prognosis

KW - Retrospective Studies

KW - Risk Factors

KW - Shock, Cardiogenic

KW - Survival Analysis

U2 - 10.1016/j.resuscitation.2014.11.010

DO - 10.1016/j.resuscitation.2014.11.010

M3 - Journal article

C2 - 25475249

SN - 0300-9572

VL - 87

SP - 57

EP - 62

JO - Resuscitation

JF - Resuscitation

ER -