Epidemiology of in-hospital cardiac arrest complicating non–ST-segment elevation myocardial infarction receiving early coronary angiography

Vallabhajosyula, Saraschandra; Vallabhajosyula, Saarwaani; Burstein, Barry; Ternus, Bradley; Sundaragiri, Pranathi R.; White, Roger D.; Barsness, Gregory W.; Jentzer, Jacob C.

doi:10.1016/j.ahj.2020.01.016

Cited by 28 publications

(33 citation statements)

References 11 publications

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“…Furthermore, traditional risk factors such as older age, minority race, non-ST-segment elevation AMI, multiorgan failure, cardiogenic shock, and presence of complications were associated with higher in-hospital mortality. Lastly, the use of coronary angiography is consistent with the lower rates, as noted in high-risk patients from other studies [1,2].…”

Section: Discussionsupporting

confidence: 83%

“…Our group and others have previously demonstrated shockable rhythms to be associated with lower in-hospital mortality. However, in this population receiving ECMO support, the type of rhythm did not influence in-hospital outcomes [1,2,15]. Furthermore, traditional risk factors such as older age, minority race, non-ST-segment elevation AMI, multiorgan failure, cardiogenic shock, and presence of complications were associated with higher in-hospital mortality.…”

Section: Discussionmentioning

confidence: 71%

“…During the period between 1 January 2000 and 31 December 2017, a retrospective cohort of admissions from the HCUP-NIS with a primary diagnosis of AMI (International Classification of Disease-9 Clinical Modification (ICD-9CM) 410.x; International Classification of Disease-10 Clinical Modification (ICD-10CM) I21.x-22.x) with concomitant IHCA (ICD-9CM 99.60, 99.63, ICD-10PCS 5A12012) was identified [1,2,6,9,15]. Prior studies have shown administrative codes to have a high sensitivity and specificity for identification of IHCA [1,2,15,16]. ECMO support was identified (ICD-9CM 39.65; ICD-10CM 5A15223) consistent with prior literature [6,9,10].…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…In-hospital cardiac arrest (IHCA) is a rare but serious complication of acute myocardial infarction (AMI) [1,2]. Despite improvements in the care of AMI patients, those experiencing IHCA continue to have 50-60% in-hospital mortality [1,2]. In recent times, the use of extracorporeal membrane oxygenation (ECMO) for supporting cardiac arrest has increased to support refractory cardiac arrest and cardiogenic shock in this population [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

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Same-Day Versus Non-Simultaneous Extracorporeal Membrane Oxygenation Support for In-Hospital Cardiac Arrest Complicating Acute Myocardial Infarction

Vallabhajosyula

Patlolla

Bell

et al. 2020

JCM

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Background: Although extracorporeal membrane oxygenation (ECMO) is used for hemodynamic support for in-hospital cardiac arrest (IHCA) complicating acute myocardial infarction (AMI), there are limited data on the outcomes stratified by the timing of initiation of this strategy. Methods: Adult (>18 years) AMI admissions with IHCA were identified using the National Inpatient Sample (2000–2017) and the timing of ECMO with relation to IHCA was identified. Same-day vs. non-simultaneous ECMO support for IHCA were compared. Outcomes of interest included in-hospital mortality, temporal trends, hospitalization costs, and length of stay. Results: Of the 11.6 million AMI admissions, IHCA was noted in 1.5% with 914 (<0.01%) receiving ECMO support. The cohort receiving same-day ECMO (N = 795) was on average female, with lower comorbidity, higher rates of ST-segment-elevation AMI, shockable rhythm, and higher rates of complications. Compared to non-simultaneous ECMO, the same-day ECMO cohort had higher rates of coronary angiography (67.5% vs. 51.3%; p = 0.001) and comparable rates of percutaneous coronary intervention (58.9% vs. 63.9%; p = 0.32). The same-day ECMO cohort had higher in-hospital mortality (63.1% vs. 44.5%; adjusted odds ratio 3.98 (95% confidence interval 2.34–6.77); p < 0.001), shorter length of stay, and lower hospitalization costs. Older age, minority race, non-ST-segment elevation AMI, multiorgan failure, and complications independently predicted higher in-hospital mortality in IHCA complicating AMI. Conclusions: Same-day ECMO support for IHCA was associated with higher in-hospital mortality compared to those receiving non-simultaneous ECMO support. Though ECMO-assisted CPR is being increasingly used, careful candidate selection is key to improving outcomes in this population.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 71%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Same-Day Versus Non-Simultaneous Extracorporeal Membrane Oxygenation Support for In-Hospital Cardiac Arrest Complicating Acute Myocardial Infarction

Vallabhajosyula

Patlolla

Bell

et al. 2020

JCM

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Influence of seasons on the management and outcomes acute myocardial infarction: An 18‐year US study

Vallabhajosyula

Patlolla

Cheungpasitporn

et al. 2020

Clinical Cardiology

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Background: There are limited data on the seasonal variation in acute myocardial infarction (AMI) in the contemporary literature. Hypothesis: There would be decrease in the seasonal variation in the management and outcomes of AMI. Methods: Adult (>18 years) AMI admissions were identified using the National Inpatient Sample (2000-2017). Seasons were classified as spring, summer, fall, and winter. Outcomes of interest included prevalence, in-hospital mortality, use of coronary angiography, and percutaneous coronary intervention (PCI). Subgroup analyses for type of AMI and patient characteristics were performed.

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Epidemiology of cardiogenic shock and cardiac arrest complicating non‐ST‐segment elevation myocardial infarction: 18‐year US study

et al. 2021

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Aims This study aims to evaluate the impact of the combination of cardiogenic shock (CS) and cardiac arrest (CA) complicating non-ST-segment elevation myocardial infarction (NSTEMI). Methods and results Adult (>18 years) NSTEMI admissions using the National Inpatient Sample database (2000 to 2017) were stratified by the presence of CA and/or CS. Outcomes of interest included in-hospital mortality, early coronary angiography, hospitalization costs, and length of stay. Of the 7 302 447 hospitalizations due to NSTEMI, 147 795 (2.0%) had CS only, 155 522 (2.1%) had CA only, and 41 360 (0.6%) had both CS and CA. Compared with 2000, the adjusted odds ratios (ORs) and 95% confidence interval (CIs) for CS, CA, and both CS and CA in 2017 were 3.75 (3.58-3.92), 1.46 (1.42-1.50), and 4.52 (4.16-4.87), respectively (all P < 0.001). The CS + CA (61.2%) cohort had higher multiorgan failure than CS (42.3%) and CA only (32.0%) cohorts, P < 0.001. The CA only cohort had lower rates of overall (52% vs. 59-60%) and early (17% vs. 18-27%) angiography compared with the other groups (all P < 0.001). CS + CA admissions had higher in-hospital mortality compared with those with CS alone (aOR 4.12 [95% CI 4.00-4.24]), CA alone (aOR 1.69 [95% CI 1.65-1.74]), or without CS/CA ). The presence of CS, either alone or with CA, was associated with higher hospitalization costs and longer hospital length of stay. Conclusions The combination of CS and CA is associated with higher rates of acute non-cardiac organ failure and in-hospital mortality in NSTEMI admissions as compared with those with either CS or CA alone.

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Epidemiology of in-hospital cardiac arrest complicating non–ST-segment elevation myocardial infarction receiving early coronary angiography

Cited by 28 publications

References 11 publications

Same-Day Versus Non-Simultaneous Extracorporeal Membrane Oxygenation Support for In-Hospital Cardiac Arrest Complicating Acute Myocardial Infarction

Same-Day Versus Non-Simultaneous Extracorporeal Membrane Oxygenation Support for In-Hospital Cardiac Arrest Complicating Acute Myocardial Infarction

Influence of seasons on the management and outcomes acute myocardial infarction: An 18‐year US study

Epidemiology of cardiogenic shock and cardiac arrest complicating non‐ST‐segment elevation myocardial infarction: 18‐year US study

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