Pre-Hospital Cardiac Arrest in Acute Coronary Syndromes: Insights from the Global Registry of Acute Coronary Events and the Canadian Registry of Acute Coronary Events

Abstract

Objectives: Cardiac arrest in acute coronary syndromes (ACS) is associated with high morbidity and mortality. We examined the clinical characteristics, contemporary management patterns and outcomes of ACS patients with pre-hospital cardiac arrest. Methods: The Global Registry of Acute Coronary Events and the Canadian Registry of Acute Coronary Events enrolled 14,010 ACS patients in 1999-2008. We compared the clinical characteristics, in-hospital treatment and outcomes between patients with and without pre-hospital cardiac arrest. Results: Overall, 206 (1.4%) patients had cardiac arrest prior to hospital presentation. ACS patients with pre-hospital cardiac arrest were less frequently treated with aspirin, β-blocker, angiotensin-converting enzyme inhibitors, and statins within the first 24 h of presentation, but the use of cardiac procedures was similar compared to the group without cardiac arrest. Patients with pre-hospital cardiac arrest had significantly higher rates of in-hospital adverse events. Factors independently associated with pre-hospital cardiac arrest included male gender, current smoker status, tachycardia, higher Killip class and ST-segment deviation. Conclusion: ACS patients with pre-hospital cardiac arrest continue to have more in-hospital complications and higher mortality. Their use of evidence-based medical therapies was lower but the use of cardiac procedures was similar compared to the group without cardiac arrest. Better utilization of evidence-based therapies in these patients may translate into improved outcomes.

Acetylsalicylic acid use is associated with reduced risk of out-of-hospital cardiac arrest in the general population: Real-world data from a population-based study

“…In contrast, ASA does inhibit the production of both compounds directly by inhibiting cyclooxygenase 1 [ 25 – 28 ]. Our findings were consistent with this expectation, and supported by an experimental study which showed that clopidogrel pre-treatment did not reduce ischemia-induced VF incidence [ 20 ], and a clinical report that, among patients with acute coronary syndrome, clopidogrel use was not different between those with or without pre-hospital cardiac arrest [ 24 ]. We observed an increased risk of OHCA in the setting of AMI upon use of clopidogrel.…”

“…This is in accordance with our findings which demonstrated reduced OHCA risk in the setting of AMI upon ASA use. Moreover, a study among patients with acute coronary syndrome found that patients who suffered pre-hospital cardiac arrest (without VT/VF documentation) were less frequently treated with ASA than patients without pre-hospital cardiac arrest [ 24 ]. However, the exposure window of ASA in that study was defined as the use of ASA prior to hospital presentation, which carries the risk of misclassification of ASA use by including past users (rather than current users) in the analysis.…”

Quality markers in cardiology: measures of outcomes and clinical practice—a perspective of the Spanish Society of Cardiology and of Thoracic and Cardiovascular Surgery

“…Comparisons should be made only between similar hospitals and in selected, well-defined, high-risk-specific populations with prognosis known to be dependent on overall cardiology management (Groups of Related Diagnosis or GRDs). 39 , 53–55 Extreme high-risk and low-prevalence groups of patients should be excluded from analysis rather than corrected for risk. 53 , 54 Sometimes this information is not well reflected in registries or databases, stressing the importance of dedicated databases for the measurement of quality outcomes.…”

“…39 , 53–55 Extreme high-risk and low-prevalence groups of patients should be excluded from analysis rather than corrected for risk. 53 , 54 Sometimes this information is not well reflected in registries or databases, stressing the importance of dedicated databases for the measurement of quality outcomes. 54 Table 3 shows the recommended populations for benchmarking.…”

Survival analysis in out-of-hospital cardiac arrest patients with shockable rhythm directly transport to Heart Centers

“…In the chain of survival, early defibrillation is a strong predictor of survival in OHCA patients with shockable rhythm [9]. Shockable rhythm is known to have a higher survival rate and higher association with acute coronary syndrome than non-shockable rhythm, with better chance of return of spontaneous circulation (ROSC) [10]. Among OHCA patients who were transported to the hospital by emergency medical technicians (EMTs), initial shockable rhythms accounted for approximately 22.9% of cases in the USA and 18.8% of cases in Taiwan in the control group [1,11].…”