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Effect of Location on Treatment and Outcomes of Cardiac Arrest Complicating Acute Myocardial Infarction in England & Wales

Effect of Location on Treatment and Outcomes of Cardiac Arrest Complicating Acute Myocardial Infarction in England & Wales
Effect of Location on Treatment and Outcomes of Cardiac Arrest Complicating Acute Myocardial Infarction in England & Wales

We investigated the incidence, management, and outcomes of acute myocardial infarction (AMI) patients according to cardiac arrest location. Patients admitted with a diagnosis of AMI between January 1, 2010 to March 31, 2017 from the Myocardial Ischaemia National Audit Project (MINAP) were studied. We used logistic regression models to evaluate predictors of the clinical outcomes and treatment strategy. The study population consisted of 580,796 patients admitted with AMI stratified into three groups: out of hospital cardiac arrest (OOHCA) (16,278[2.8%]), in-hospital cardiac arrest (IHCA) (21,073[3.7%]), plus a reference group consisting of those without cardiac arrest (non-cardiac arrest (543,418[93.5%]). IHCA declined steadily (from 666 per 1000 in 2010 to 477 per 1000 AMI with cardiac arrest admissions in 2017) with a commensurate rise in OOHCA (from 344 per 1000 to 533 per 1000 AMI with cardiac arrest admissions). Coronary angiography utilization (OOHCA 81.1% vs IHCA 60.3% vs non-cardiac arrest 70.4%, p < 0.001) and PCI (OOHCA 40% vs IHCA 32.8% vs non-cardiac arrest 45.2%, p < 0.001) were higher in OOHCA. In-hospital mortality odds were greatest for IHCA (OR 35.3, 95% CI 33.4-37.2) compared to OOHCA (OR 12.7, 95% CI 11.9-13.6), with the worse outcomes seen in patients on medical wards (OR 97.37, 95% CI 87.02-108.95) and the best outcomes seen in the emergency department (OR 8.35, 95% CI 7.32-9.53). In conclusion, outcomes of AMI complicated by cardiac arrest depended on cardiac arrest location, especially the outcomes of the IHCA.

0002-9149
1-10
Dafaalla, Mohamed
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Rashid, Muhammad
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Weston, Clive
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Kinnaird, Tim
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Gurm, Hitinder
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Appleby, Clare
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Shoaib, Ahmad
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Stevens, Chris
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Alraies, Chadi M
c39a3f17-1b0c-4f86-a3a6-fb48d7e285b4
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Mamas, Mamas A
41515b72-75ff-4922-bb9f-8f9c63f9f5af
Dafaalla, Mohamed
279931ef-91c9-4753-b8b8-f79b0d58f887
Rashid, Muhammad
f974c0d2-bd55-4d93-940e-1cce3dd0fd59
Weston, Clive
deabff0b-b4c9-4104-b803-32041cb6d2c7
Kinnaird, Tim
3cfe5aa5-eb28-4a4d-b2e4-6ea0799d85d0
Gurm, Hitinder
17ff8931-7ce9-4aff-b769-83a7eb87fdc3
Appleby, Clare
bb8e2e92-71fa-4270-9382-f2923f02c2b1
Shoaib, Ahmad
87d9fdcb-a5ce-4379-8280-3115040dc364
Stevens, Chris
76d6d076-fa18-4bac-bf4e-d256df18824a
Alraies, Chadi M
c39a3f17-1b0c-4f86-a3a6-fb48d7e285b4
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Mamas, Mamas A
41515b72-75ff-4922-bb9f-8f9c63f9f5af

Dafaalla, Mohamed, Rashid, Muhammad, Weston, Clive, Kinnaird, Tim, Gurm, Hitinder, Appleby, Clare, Shoaib, Ahmad, Stevens, Chris, Alraies, Chadi M, Curzen, Nick and Mamas, Mamas A (2021) Effect of Location on Treatment and Outcomes of Cardiac Arrest Complicating Acute Myocardial Infarction in England & Wales. The American Journal of Cardiology, 152, 1-10. (doi:10.1016/j.amjcard.2021.04.032).

Record type: Article

Abstract

We investigated the incidence, management, and outcomes of acute myocardial infarction (AMI) patients according to cardiac arrest location. Patients admitted with a diagnosis of AMI between January 1, 2010 to March 31, 2017 from the Myocardial Ischaemia National Audit Project (MINAP) were studied. We used logistic regression models to evaluate predictors of the clinical outcomes and treatment strategy. The study population consisted of 580,796 patients admitted with AMI stratified into three groups: out of hospital cardiac arrest (OOHCA) (16,278[2.8%]), in-hospital cardiac arrest (IHCA) (21,073[3.7%]), plus a reference group consisting of those without cardiac arrest (non-cardiac arrest (543,418[93.5%]). IHCA declined steadily (from 666 per 1000 in 2010 to 477 per 1000 AMI with cardiac arrest admissions in 2017) with a commensurate rise in OOHCA (from 344 per 1000 to 533 per 1000 AMI with cardiac arrest admissions). Coronary angiography utilization (OOHCA 81.1% vs IHCA 60.3% vs non-cardiac arrest 70.4%, p < 0.001) and PCI (OOHCA 40% vs IHCA 32.8% vs non-cardiac arrest 45.2%, p < 0.001) were higher in OOHCA. In-hospital mortality odds were greatest for IHCA (OR 35.3, 95% CI 33.4-37.2) compared to OOHCA (OR 12.7, 95% CI 11.9-13.6), with the worse outcomes seen in patients on medical wards (OR 97.37, 95% CI 87.02-108.95) and the best outcomes seen in the emergency department (OR 8.35, 95% CI 7.32-9.53). In conclusion, outcomes of AMI complicated by cardiac arrest depended on cardiac arrest location, especially the outcomes of the IHCA.

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More information

Accepted/In Press date: 14 April 2021
e-pub ahead of print date: 12 June 2021
Published date: 1 August 2021

Identifiers

Local EPrints ID: 453262
URI: http://eprints.soton.ac.uk/id/eprint/453262
ISSN: 0002-9149
PURE UUID: c8db09fb-b445-4b11-bdde-68e2135e2602
ORCID for Nick Curzen: ORCID iD orcid.org/0000-0001-9651-7829

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Date deposited: 11 Jan 2022 17:50
Last modified: 11 Jul 2024 01:43

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Contributors

Author: Mohamed Dafaalla
Author: Muhammad Rashid
Author: Clive Weston
Author: Tim Kinnaird
Author: Hitinder Gurm
Author: Clare Appleby
Author: Ahmad Shoaib
Author: Chris Stevens
Author: Chadi M Alraies
Author: Nick Curzen ORCID iD
Author: Mamas A Mamas

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