Author + information
- Received December 23, 2019
- Revision received April 2, 2020
- Accepted April 3, 2020
- Published online May 18, 2020.
- Mohamed A. Omer, MD, MSa,
- Jeffrey M. Tyler, MDb,
- Timothy D. Henry, MDc,
- Ross Garberich, MS, MBAa,
- Scott W. Sharkey, MDa,
- Christian W. Schmidt, MSa,
- Jason T. Henry, MDa,
- Peter Eckman, MDa,
- Michael Megaly, MDa,
- Emmanouil S. Brilakis, MD, PhDa,
- Ivan Chavez, MDa,
- Nicholas Burke, MDa,
- Mario Gössl, MD, PhDa,
- Michael Mooney, MDa,
- Paul Sorajja, MDa,
- Jay H. Traverse, MDa,
- Yale Wang, MDa,
- Katarzyna Hryniewicz, MDa and
- Santiago Garcia, MDa,∗ ()
- aMinneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
- bDepartment of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, California
- cLindner Center for Research and Education, Christ Hospital, Cincinnati, Ohio
- ↵∗Address for correspondence:
Dr. Santiago Garcia, Minneapolis Heart Institute, 920 East 28th Street (Suite #300), Minneapolis, Minnesota 55407.
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.
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.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.
- Received December 23, 2019.
- Revision received April 2, 2020.
- Accepted April 3, 2020.
- 2020 American College of Cardiology Foundation
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