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

2020 ◽  
Vol 9 (8) ◽  
pp. 2613
Author(s):  
Saraschandra Vallabhajosyula ◽  
Sri Harsha Patlolla ◽  
Malcolm R. Bell ◽  
Wisit Cheungpasitporn ◽  
John M. Stulak ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Ecmo Support ◽  
St Segment Elevation ◽  
St Segment ◽  
Hospitalization Costs ◽  
Hospital Cardiac Arrest

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.

scholarly journals Impact of Coronavirus Disease 2019 Pandemic on the Incidence and Management of Out‐of‐Hospital Cardiac Arrest in Patients Presenting With Acute Myocardial Infarction in England

2020 ◽  
Vol 9 (22) ◽  
Author(s):  
Muhammad Rashid (Hons) ◽  
Chris P. Gale (Hons) ◽  
Nick Curzen (Hons) ◽  
Peter Ludman (Hons) ◽  
Mark De Belder (Hons) ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Arrest ◽  
Hospital Mortality ◽  
Invasive Coronary Angiography ◽  
Temporal Trends ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Hospital Cardiac Arrest

Background Studies have reported significant reduction in acute myocardial infarction–related hospitalizations during the coronavirus disease 2019 (COVID‐19) pandemic. However, whether these trends are associated with increased incidence of out‐of‐hospital cardiac arrest (OHCA) in this population is unknown. Methods and Results Acute myocardial infarction hospitalizations with OHCA during the COVID‐19 period (February 1–May 14, 2020) from the Myocardial Ischaemia National Audit Project and British Cardiovascular Intervention Society data sets were analyzed. Temporal trends were assessed using Poisson models with equivalent pre–COVID‐19 period (February 1–May 14, 2019) as reference. Acute myocardial infarction hospitalizations during COVID‐19 period were reduced by >50% (n=20 310 versus n=9325). OHCA was more prevalent during the COVID‐19 period compared with the pre–COVID‐19 period (5.6% versus 3.6%), with a 56% increase in the incidence of OHCA (incidence rate ratio, 1.56; 95% CI, 1.39–1.74). Patients experiencing OHCA during COVID‐19 period were likely to be older, likely to be women, likely to be of Asian ethnicity, and more likely to present with ST‐segment–elevation myocardial infarction. The overall rates of invasive coronary angiography (58.4% versus 71.6%; P <0.001) were significantly lower among the OHCA group during COVID‐19 period with increased time to reperfusion (mean, 2.1 versus 1.1 hours; P =0.05) in those with ST‐segment–elevation myocardial infarction. The adjusted in‐hospital mortality probability increased from 27.7% in February 2020 to 35.8% in May 2020 in the COVID‐19 group ( P <.001). Conclusions In this national cohort of hospitalized patients with acute myocardial infarction, we observed a significant increase in incidence of OHCA during COVID‐19 period paralleled with reduced access to guideline‐recommended care and increased in‐hospital mortality.

scholarly journals Predictors Of Mortality In Patients With ST-Segment Elevation Acute Myocardial Infarction And Resuscitated Out-Of-Hospital Cardiac Arrest

2016 ◽  
Vol 2 (1) ◽  
pp. 22-29 ◽  
Author(s):  
Andreea Bărcan ◽  
Monica Chițu ◽  
Edvin Benedek ◽  
Nora Rat ◽  
Szilamer Korodi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Renal Failure ◽  
Cardiac Arrest ◽  
Cardiogenic Shock ◽  
St Segment Elevation ◽  
Survivor Group ◽  
St Segment ◽  
Infarct Related Artery ◽  
Hospital Cardiac Arrest

Abstract Introduction: In patients with out-of-hospital cardiac arrest (OHCA) complicating an ST-segment elevation myocardial infarction (STEMI), the survival depends largely on the restoration of coronary flow in the infarct related artery. The aim of this study was to determine clinical and angiographic predictors of in-hospital mortality in patients with OHCA and STEMI, successfully resuscitated and undergoing primary percutaneous intervention (PCI).Methods: From January 2013 to July 2015, 78 patients with STEMI presenting OHCA, successfully resuscitated, transferred immediately to the catheterization unit and treated with primary PCI, were analyzed. Clinical, laboratory and angiographic data were compared in 28 non-survivors and 50 survivors.Results: The clinical baseline characteristics of the study population showed no significant differences between the survivors and non-survivors in respect to age (p=0.06), gender (p=0.8), the presence of hypertension (p=0.4), dyslipidemia (p=0.09) obesity (p=1), smoking status (p=0.2), presence of diabetes (p=0.2), a clinical history of acute myocardial infarction (p=0.7) or stroke (p=0.17). Compared to survivors, the non-survivor group exhibited a significantly higher incidence of cardiogenic shock (50% vs 24%, p=0.02), renal failure (64.3% vs 30.0%, p=0.004) and anaemia (35.7% vs 12.0%, p=0.02). Three-vessel disease was significantly higher in the non-survivor group (42.8% vs. 20.0%, p=0.03), while there was a significantly higher percentage of TIMI 3 flow postPCI in the infarct-related artery in the survivor group (80.% vs. 57.1%, p=0.03). The time from the onset of symptoms to revascularization was significantly higher in patients who died compared to those who survived (387.5 +/- 211.3 minutes vs 300.8 +/- 166.1 minutes, p=0.04), as was the time from the onset of cardiac arrest to revascularization (103.0 +/- 56.34 minutes vs 67.0 +/- 44.4 minutes, p=0.002). Multivariate analysis identified the presence of cardiogenic shock (odds ratio [OR]: 3.17, p=0.02), multivessel disease (OR: 3.0, p=0.03), renal failure (OR: 4.2, p=0.004), anaemia (OR: 4.07, p=0.02), need for mechanical ventilation >48 hours (OR: 8.07, p=0.0002) and a duration of stay in the ICU longer than 5 days (OR: 9.96, p=0.0002) as the most significant independent predictors for mortality in patients with OHCA and STEMI.Conclusion: In patients surviving an OHCA in the early phase of a myocardial infarction, the presence of cardiogenic shock, renal failure, anaemia or multivessel disease, as well as a longer time from the onset of symptoms or of cardiac arrest to revascularization, are independent predictors of mortality. However, the most powerful predictor of death is the duration of stay in the ICU and the requirement of mechanical ventilation for more than forty-eight hours.

scholarly journals Modern treatment of acute myocardial infarction with ST-segment elevation complicated with out-of-hospital cardiac arrest

2018 ◽  
Vol 37 (1) ◽  
pp. 6-8
Author(s):  
Ratko Lasica ◽  
Mina Radosavljević-Radovanović ◽  
Predrag Mitrović ◽  
Ana Ušćumlić ◽  
Igor Mrdović ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Arrest ◽  
St Segment Elevation ◽  
St Segment ◽  
Modern Treatment ◽  
Hospital Cardiac Arrest

scholarly journals Temporal Trends, Predictors, and Outcomes of Acute Ischemic Stroke in Acute Myocardial Infarction in the United States

2021 ◽  
Author(s):  
Gaurav Aggarwal ◽  
Sri Harsha Patlolla ◽  
Saurabh Aggarwal ◽  
Wisit Cheungpasitporn ◽  
Rajkumar Doshi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Temporal Trends ◽  
St Segment Elevation ◽  
Endoscopic Gastrostomy ◽  
St Segment ◽  
Hospitalization Costs

Background There are limited contemporary data prevalence and outcomes of acute ischemic stroke (AIS) complicating acute myocardial infarction (AMI). Methods and Results Adult (>18 years) AMI admissions using the National Inpatient Sample database (2000–2017) were evaluated for in‐hospital AIS. Outcomes of interest included in‐hospital mortality, hospitalization costs, length of stay, discharge disposition, and use of tracheostomy and percutaneous endoscopic gastrostomy. The discharge destination was used to classify survivors into good and poor outcomes. Of a total 11 622 528 AMI admissions, 183 896 (1.6%) had concomitant AIS. As compared with 2000, in 2017, AIS rates increased slightly among ST‐segment–elevation AMI (adjusted odds ratio, 1.10 [95% CI, 1.04–1.15]) and decreased in non–ST‐segment–elevation AMI (adjusted odds ratio, 0.47 [95% CI, 0.46–0.49]) admissions ( P <0.001). Compared with those without, the AIS cohort was on average older, female, of non‐White race, with greater comorbidities, and higher rates of arrhythmias. The AMI‐AIS admissions received less frequent coronary angiography (46.9% versus 63.8%) and percutaneous coronary intervention (22.7% versus 41.8%) ( P <0.001). The AIS cohort had higher in‐hospital mortality (16.4% versus 6.0%; adjusted odds ratio, 1.75 [95% CI, 1.72–1.78]; P <0.001), longer hospital length of stay, higher hospitalization costs, greater use of tracheostomy and percutaneous endoscopic gastrostomy, and less frequent discharges to home (all P <0.001). Among AMI‐AIS survivors (N=153 318), 57.3% had a poor functional outcome at discharge with relatively stable temporal trends. Conclusions AIS is associated with significantly higher in‐hospital mortality and poor functional outcomes in AMI admissions.

scholarly journals Complications in Patients with Acute Myocardial Infarction Supported with Extracorporeal Membrane Oxygenation

2020 ◽  
Vol 9 (3) ◽  
pp. 839 ◽  
Author(s):  
Saraschandra Vallabhajosyula ◽  
Malcolm R. Bell ◽  
Gurpreet S. Sandhu ◽  
Allan S. Jaffe ◽  
David R. Holmes ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Lower Limb ◽  
Temporal Trends ◽  
Ecmo Support ◽  
Limb Amputation ◽  
Membrane Oxygenation ◽  
Hospitalization Costs

Background: There are limited data on complications in acute myocardial infarction (AMI) admissions receiving extracorporeal membrane oxygenation (ECMO). Methods: Adult (>18 years) admissions with AMI receiving ECMO support were identified from the National Inpatient Sample database between 2000 and 2016. Complications were classified as vascular, lower limb amputation, hematologic, and neurologic. Outcomes of interest included temporal trends, in-hospital mortality, hospitalization costs, and length of stay. Results: In this 17-year period, in ~10 million AMI admissions, ECMO support was used in 4608 admissions (<0.01%)—mean age 59.5 ± 11.0 years, 75.7% men, 58.9% white race. Median time to ECMO placement was 1 (interquartile range [IQR] 0–3) day. Complications were noted in 2571 (55.8%) admissions—vascular 6.1%, lower limb amputations 1.1%, hematologic 49.3%, and neurologic 9.9%. There was a steady increase in overall complications during the study period (21.1% in 2000 vs. 70.5% in 2016). The cohort with complications, compared to those without complications, had comparable adjusted in-hospital mortality (60.7% vs. 54.0%; adjusted odds ratio 0.89 [95% confidence interval 0.77–1.02]; p = 0.10) but longer median hospital stay (12 [IQR 5–24] vs. 7 [IQR 3–21] days), higher median hospitalization costs ($458,954 [IQR 260,522–737,871] vs. 302,255 [IQR 173,033–623,660]), fewer discharges to home (14.7% vs. 17.9%), and higher discharges to skilled nursing facilities (44.1% vs. 33.9%) (all p < 0.001). Conclusions: Over half of all AMI admissions receiving ECMO support develop one or more severe complications. Complications were associated with higher resource utilization during and after the index hospitalization.

scholarly journals New Developments in the Treatment of Acute Myocardial Infarction Associated with Out-of-Hospital Cardiac Arrest. A Review

2016 ◽  
Vol 2 (4) ◽  
pp. 151-158
Author(s):  
Monica Marton-Popovici ◽  
Dietmar Glogar
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Arrest ◽  
Life Support ◽  
Current Knowledge ◽  
St Segment Elevation ◽  
Catheterization Laboratory ◽  
St Segment ◽  
Percutaneous Revascularization ◽  
Hospital Cardiac Arrest

Abstract Out-of-hospital cardiac arrest (OHCA) occurring as the first manifestation of an acute myocardial infarction is associated with very high mortality rates. As in comatose patients the etiology of cardiac arrest may be unclear, especially in cases without ST-segment elevation on the surface electrocardiogram, the decision to perform or not to perform urgent coronary angiography can have a significant impact on the prognosis of these patients. This review summarises the current knowledge and recommendations for treating patients with acute myocardial infarction presenting with OHCA. New therapeutic measures for the post-resuscitation phase are presented, such as hypothermia or extracardiac life support, together with strategies aiming to restore the coronary flow in the resuscitation phase using intra-arrest percutaneous revascularization performed during resuscitation. The role of regional networks in providing rapid access to the hospital facilities and to a catheterization laboratory for these critical cardiovascular emergencies is described.

scholarly journals Temporal Trends, Clinical Characteristics and Outcomes of Emergent Coronary Artery Bypass Grafting for Acute Myocardial Infarction in the United States

2021 ◽  
Author(s):  
Sri Harsha Patlolla ◽  
Ardaas Kanwar ◽  
Wisit Cheungpasitporn ◽  
Rajkumar P Doshi ◽  
John M Stulak ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Hospital Mortality ◽  
Artery Bypass ◽  
Temporal Trends ◽  
Bypass Grafting ◽  
St Segment Elevation ◽  
St Segment ◽  
Hospitalization Costs

Abstract Background There are limited contemporary data on the use of emergent coronary artery bypass grafting (CABG) in acute myocardial infarction (AMI). Methods and Results Adult (>18 years) AMI admissions were identified using the National Inpatient Sample (2000‐2017) and classified by tertiles of admission year. Outcomes of interest included temporal trends of CABG use, age‐, sex‐, and race‐stratified trends in CABG use, in‐hospital mortality, hospitalization costs, and hospital length of stay. Of the 11,622,528 AMI admissions, emergent CABG was performed in 1,071,156 (9.2%). CABG utilization decreased overall (10.5% [2000] to 8.7% [2017]; adjusted odds ratio [OR] 0.98 [95% confidence interval {CI} 0.98‐0.98]; p<0.001), in ST‐segment‐elevation AMI (STEMI) (10.2% [2000] to 5.2% [2017]; adjusted OR 0.95 [95% CI 0.95‐0.95]; p<0.001) and non‐ST‐segment‐elevation AMI (NSTEMI) (10.8% [2000] to 10.0% [2017]; adjusted OR 0.99 [95% CI 0.99‐0.99]; p<0.001), with consistent age, sex and race trends. In 2012‐2017, compared to 2000‐2005, admissions receiving emergent CABG were more likely to have NSTEMI (80.5% vs. 56.1%), higher rates of non‐cardiac multiorgan failure (26.1% vs. 8.4%), cardiogenic shock (11.5% vs. 6.4%) and use of mechanical circulatory support (19.8% vs. 18.7%). In‐hospital mortality in CABG admissions decreased from 5.3% [2000] to 3.6% [2017]; adjusted OR 0.89 [95% CI 0.88‐0.89]; p<0.001 in the overall cohort, with similar temporal trends in STEMI and NSTEMI. An increase in lengths of hospital stay and hospitalization costs was seen over time. Conclusions Utilization of CABG has decreased substantially in AMI admissions, especially in STEMI. Despite an increase in acuity and multi‐organ failure, in‐hospital mortality consistently decreased this population.

P5502Comparison of clinical characteristics and prognosis between non-octogenarians and octogenarians with cardiac troponin positive acute myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Soeda ◽  
M Ishihara ◽  
F Fujino ◽  
H Ogawa ◽  
K Nakao ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiac Troponin ◽  
Clinical Characteristics ◽  
St Segment Elevation ◽  
The Poor ◽  
St Segment ◽  
Universal Definition ◽  
Multicenter Registry

Abstract Background Cardiac troponin (cTn) is the preferred biomarker for the diagnosis of acute myocardial infarction (AMI). Octogenarians who presented cTn positive AMI are not usually recruited in clinical trials. Therefore, their clinical characteristics and prognosis are rarely investigated. Objective To study the characteristics and prognosis in octogenarians who presented cTn positive AMI. Methods and results The Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET) is a prospective and multicenter registry. A total of 3,283 consecutive AMI patients who were diagnosed by cTn-based criteria were included. The patients were divided into non-octogenarians (n=2,593) and octogenarians (n=690). Compared with non- octogenarians, octogenarians showed significantly lower incidence of diabetes mellitus (37.6% and 31.9%, p=0.006) and dyslipidemia (53.6% and 45.6%, p<0.001), and significantly higher incidence of hypertension (64.1% and 75.3%, p<0.001) and chronic kidney disease (38.7% and 68.7%, p<0.001). Octogenarians showed significantly longer onset to door time (p<0.001) and longer door to device time (p<0.001). Though, compared with non-octogenarians, octogenarians showed lower peak CK (2,506 and 1,926, p<0.001), LVEF was significantly lower in octogenarians (54.6% and 52.6%, p=0.005). The presentation of AMI was different between the two group. The incidence of ST-segment elevation MI (STEMI) was 70.7% in non-octogenarians and 62.0% in octogenarians. Non-STEMI with CK elevation and without CK elevation were 16.2% and 13.1% in non- octogenarians, and 20.9% and 17.1% in octogenarians. In-hospital mortality was higher in octogenarians (4.7% and 13.2%, P<0.001). Especially, octogenarians with STEMI and non-STEMI with CK elevation showed the highest in-hospital mortality. And octogenarians without CK elevation showed similar in hospital mortality with non-octogenarians with STEMI (Figure). Conclusions J-MINUET showed the poor prognosis of octogenarians who were diagnosed as AMI based on cTn. Acknowledgement/Funding None

Abstract 127: Racial Disparities in Management and Outcomes of Cardiac Arrest Complicating Acute Myocardial Infarction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Anna Subramaniam ◽  
Sri Harsha Patlolla ◽  
Saraschandra Vallabhajosyula
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Arrest ◽  
Coronary Angiography ◽  
Hospital Mortality ◽  
Racial Disparities ◽  
Racial Minorities ◽  
White Race ◽  
Black Race ◽  
Hospitalization Costs

Introduction: Racial disparities in outcomes of acute myocardial infarction (AMI) and cardiac arrest (CA) exist. This study assessed the racial differences in the management and outcomes of CA complicating AMI to better inform clinical care. Hypothesis: We hypothesized that racial minorities would have worse outcomes with AMI-CA as compared to white patients. Methods: During 2012-2017, AMI admissions with a concomitant diagnosis of CA were identified from the National Inpatient Sample. Race was classified as white, black and others (Hispanic, Asian or Pacific Islander, Native American, Others). The primary outcome was racial disparities in in-hospital mortality. Secondary outcomes included racial disparities in invasive procedures and hospitalization characteristics. Results: We identified 3,504,225 admissions for AMI in the study period, of which 182,750 (5.2%) were complicated by CA. 74.8% were white, 10.7% were black and 14.5% belonged to other races. Black and other race AMI-CA admissions received less frequent early coronary angiography (41.4% vs 50.2% vs 52.8%), coronary angiography (61.9% vs 70.2% vs. 73.1% %), PCI (44.6% vs 53.0% vs 58.1%), CABG and mechanical circulatory support compared to white and other races. The mean time to coronary angiography was highest among blacks (3.4 ± 4.2 days) and lowest among whites (3.0 ± 3.7 days). Black and other races had significantly higher unadjusted mortality, however in a multivariable logistic regression analysis with white race as referent, black race was associated with lower in-hospital mortality (OR 0.95 [95% CI 0.91-0.99]; p =0.007) whereas other races had higher in-hospital mortality (OR 1.11 [95% CI 1.08-1.15]; p <0.001) compared to white race. AMI-CA admissions of black race had longer length of hospital stay, higher rates of palliative care consultation, less frequent DNR status use, and fewer discharges to home. Admissions of other races had higher use of DNR status and higher hospitalization costs compared to whites and blacks. Conclusions: Significant racial disparities exist in in-hospital mortality among AMI admissions complicated with CA. Further quantitative and qualitative research into the equitable care of racial minorities with AMI-CA is needed to address this disparity.

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