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PROHLÍŽENÍ ABSTRAKTA

THE IMPACT OF CARDIOGENIC SHOCK AND OUT-OF-HOSPITAL CARDIAC ARREST ON THE OUTCOME OF ACUTE MYOCARDIAL INFARCTION. NATIONAL LEVEL ANALYSIS.
Tématický okruh: Akutní koronární syndromy
Typ: Ústní sdělení - lékařské , Číslo v programu: 26
Tomašov P.1, Moťovská Z.2, Hlinomaz O.3, Kala P.4, Šramko M.5, Mrózek J.6, Hromádka M.7, Přeček J.8, Bis J.9, Matějka J.10, Červinka P.11, Kovářík A.12, Škňouřil L.13, Coufal Z.14, Jarkovský J.15

1 Kardiocentrum, Krajská nemocnice Liberec, Liberec, 2 Cardiocenter, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady, Prague, 3 First Department of Internal Medicine and Cardioangiology, International Clinical Research Center, Faculty of Medicine, St. Anne's University Hospital, Masaryk University, Brno, 4 Department of Internal Medicine and Cardiology, Faculty of Medicine, University Hospital of Brno, Masaryk University, Brno, 5 Cardiology, Institute of Clinical and Experimental Medicine, Prague, 6 Department Cardiovascular Surgery, University Hospital of Ostrava, Ostrava, 7 Cardiology, Faculty of Medicine in Pilsen, University Hospital of Pilsen, Charles University, Plzeň, 8 Department of Internal Medicine I and Cardiology, Faculty of Medicine and Dentistry, University Hospital of Olomouc, Palacky University, Olomouc, 9 Departmet of Cardiolovascular Medicine, University Hospital of Hradec Kralove, Hradec Králové, 10 Cardiology, Hospital of Pardubice, 11 Cardiology, Krajska Zdravotni A.S., Masaryk Hospital, Jan Evangelista Purkyne University, Ústí nad Labem, 12 Cardiocenter, Regional Hospital České Budějovice, České Budějovice, 13 Cardiology, Nemocnice Agel, Třinec-Podlesí, 14 Cardiology, T. Bata Regional Hospital Zlin, Zlín, 15 Institute of Health Information and Statistics of the Czech Republic, Prague


Background: Cardiogenic shock (CS) and out-of-hospital cardiac arrest (OHCA) are critical cardiovascular events with profound implications for patient outcomes. This study aims to provide a national level analysis of predictors of CS and OHCA in acute myocardial infarction (AMI) patients and their effect on mortality.

Methods: The analysis is based on data from an all-comers national registry. The 2016-2020 period was chosen for standardized registry data, and 23,703 ST-elevation myocardial infarction (STEMI) patients were analyzed.

Results: We compared 4 subgroups of STEMI patients, A) without CS and OHCA (19,590), B) after OHCA (2,262), C) with CS (713), and D) after OHCA with CS (1,138). Patients after OHCA without CS had the lowest mean age, 62.0 (+/-12.6) years, while patients with CS without OHCA were the oldest, 68.8 (+/-11.8) years. Patients with CS without OHCA had the highest proportions of comorbidities, namely diabetes mellitus (25.0%), chronic kidney disease (6.0%), prior percutaneous coronary intervention (18.8%), and prior coronary artery bypass graft (5.3%). Mortality at 30 days was highest in CS patients complicated by OHCA (48.2%), followed by CS patients without OHCA (42.8%), patients with OHCA without CS (10.6%) and patients without CS and OHCA (4.0%). CS was the most robust predictor of 30-day mortality, odds ratio (OR) 6.627 (95% confidence interval (CI) 5.453; 8.054) for patients after OHCA and 10.352 (8.483; 12.634) for those without OHCA.

Conclusion: OHCA significantly altered the 30-day mortality risk after STEMI for both patients with and without CS. CS is the strongest predictor of 30-day mortality in STEMI, irrespective of OHCA. STEMI patients after OHCA and CS at admission are at the highest risk of death.