Cardiac arrest in patients with acute left main coronary artery occlusion: a real-world multicenter registry

Abstract

Funding Acknowledgements Type of funding sources: None. Introduction and objective Acute coronary syndrome (ACS) patients with unprotected left main coronary artery (LMCA) occlusion are at increased risk of mortality. Most studies have shown an association between LMCA occlusion and cardiac arrest. We aimed to evaluate the clinical characteristics and the prognosis of patients with ACS due to LMCA occlusion with cardiac arrest at presentation. Methods We performed a retrospective multicenter study of 128 consecutive patients with ACS due to LMCA occlusion admitted in three Portuguese tertiary hospitals between 2008 and 2020. Patients were divided according to the presentation with cardiac arrest. Results Among this cohort, 26% patients presented with cardiac arrest. Regarding baseline characteristics, they were younger (58 vs 65 years; p=0.001) but no other significant differences were found. Cardiac arrest was associated to shorter symptoms-to-balloon time (150 vs 195 minutes; p=0.042) and higher recourse to fibrinolysis (12.1% vs 0%, p=0.004). They also had higher prevalence of cardiogenic shock (88% vs 51%; p<0.001) and need for aminergic support (91% vs 64%; p=0.004). Furthermore, in-hospital (79% vs 45%; p=0.001) and 5-year (97% vs 73%; p=0.008) mortality were significantly higher, as predicted by Kaplan-Meier survival curves (p=0.002; log-rank test). Finally, in multivariable analysis, younger age [odds ratio (OR),1.12;95% CI,1.04-1.20] and lower median symptoms-to-balloon time (OR, 1.35;95% CI,1.02-1.82) were independently associated to cardiac arrest at presentation. Conclusion In our real-world cohort, more than one quarter of patients with ACS due to LMCA occlusion presented with cardiac arrest, which correlates to a higher incidence of cardiogenic shock, as well as higher short- and long-term mortality. Only younger age and lower symptoms-to-balloon time were independently associated to cardiac arrest. Despite cardiac care improvements, technological evolution, and better patient/system-delay times, this is still a subpopulation with poor prognosis. Further studies are needed to find innovative strategies that can make a difference in this subgroup of patients.