Early vs. delayed in-hospital cardiac arrest complicating ST-elevation myocardial infarction receiving primary percutaneous coronary intervention

Saraschandra Vallabhajosyula, Saarwaani Vallabhajosyula, Malcolm R. Bell, Abhiram Prasad, Mandeep Singh, Roger D. White, Allan S. Jaffe, David R. Holmes, Jacob C. Jentzer

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)242-250
Number of pages9
JournalResuscitation
Volume148
DOIs
StatePublished - Mar 1 2020

Keywords

  • Critical care cardiology
  • In-hospital cardiac arrest
  • National Inpatient Sample
  • Outcomes research
  • ST-elevation myocardial infarction

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

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