TY - JOUR
T1 - Early vs. delayed in-hospital cardiac arrest complicating ST-elevation myocardial infarction receiving primary percutaneous coronary intervention
AU - Vallabhajosyula, Saraschandra
AU - Vallabhajosyula, Saarwaani
AU - Bell, Malcolm R.
AU - Prasad, Abhiram
AU - Singh, Mandeep
AU - White, Roger D.
AU - Jaffe, Allan S.
AU - Holmes, David R.
AU - Jentzer, Jacob C.
N1 - Publisher Copyright:
© 2019 Elsevier B.V.
PY - 2020/3/1
Y1 - 2020/3/1
N2 - Background: There are limited data on the timing and outcomes of in-hospital cardiac arrest (IHCA) in patients with ST-elevation myocardial infarction (STEMI) receiving primary percutaneous coronary intervention (pPCI). This study sought to examine the in-hospital mortality, temporal trends and resource utilization in early vs. delayed IHCA in STEMI. Methods: Retrospective cohort study from the National Inpatient Sample of all STEMI admissions during 2000–2014 receiving pPCI on hospital day zero. Admissions transferred from other hospitals, with do-not-resuscitate status, without information on IHCA timing, and receiving surgical revascularization were excluded. IHCA was classified as early (hospital day zero) and delayed (on/after hospital day 1). The primary outcome was in-hospital mortality and secondary outcomes included prevalence, temporal trends, and resource utilization. Results: During this 15-year period, 19,185 admissions met the inclusion criteria, with 15,404 (80%) experiencing an early IHCA. The cohort with delayed IHCA was on average older, female, with higher comorbidity, and greater prevalence of non-shockable rhythms and acute organ failure. There was a temporal increase in early IHCA (adjusted odds ratio [aOR] 1.67 [95% confidence interval {CI} 1.35–2.08]) and a decrease in delayed IHCA (aOR 0.60 [95% CI 0.48-0.74]) in 2014 compared to 2000. Compared to the early IHCA cohort, the delayed IHCA cohort had higher in-hospital mortality (aOR 5.35 [95% CI 4.83–5.94]), higher hospitalization costs ($115,165 ± 109,848 vs. 139,038 ± 142,745) and less frequent discharges to home (74% vs. 52%). Conclusions: Delayed IHCA (on or after hospital day 1) was associated with higher in-hospital mortality and resource utilization compared to early IHCA.
AB - Background: There are limited data on the timing and outcomes of in-hospital cardiac arrest (IHCA) in patients with ST-elevation myocardial infarction (STEMI) receiving primary percutaneous coronary intervention (pPCI). This study sought to examine the in-hospital mortality, temporal trends and resource utilization in early vs. delayed IHCA in STEMI. Methods: Retrospective cohort study from the National Inpatient Sample of all STEMI admissions during 2000–2014 receiving pPCI on hospital day zero. Admissions transferred from other hospitals, with do-not-resuscitate status, without information on IHCA timing, and receiving surgical revascularization were excluded. IHCA was classified as early (hospital day zero) and delayed (on/after hospital day 1). The primary outcome was in-hospital mortality and secondary outcomes included prevalence, temporal trends, and resource utilization. Results: During this 15-year period, 19,185 admissions met the inclusion criteria, with 15,404 (80%) experiencing an early IHCA. The cohort with delayed IHCA was on average older, female, with higher comorbidity, and greater prevalence of non-shockable rhythms and acute organ failure. There was a temporal increase in early IHCA (adjusted odds ratio [aOR] 1.67 [95% confidence interval {CI} 1.35–2.08]) and a decrease in delayed IHCA (aOR 0.60 [95% CI 0.48-0.74]) in 2014 compared to 2000. Compared to the early IHCA cohort, the delayed IHCA cohort had higher in-hospital mortality (aOR 5.35 [95% CI 4.83–5.94]), higher hospitalization costs ($115,165 ± 109,848 vs. 139,038 ± 142,745) and less frequent discharges to home (74% vs. 52%). Conclusions: Delayed IHCA (on or after hospital day 1) was associated with higher in-hospital mortality and resource utilization compared to early IHCA.
KW - Critical care cardiology
KW - In-hospital cardiac arrest
KW - National Inpatient Sample
KW - Outcomes research
KW - ST-elevation myocardial infarction
UR - http://www.scopus.com/inward/record.url?scp=85076221440&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85076221440&partnerID=8YFLogxK
U2 - 10.1016/j.resuscitation.2019.11.007
DO - 10.1016/j.resuscitation.2019.11.007
M3 - Article
C2 - 31759071
AN - SCOPUS:85076221440
SN - 0300-9572
VL - 148
SP - 242
EP - 250
JO - Resuscitation
JF - Resuscitation
ER -