Outcomes After Percutaneous Coronary Intervention of Acute Coronary Syndrome Complicated With Cardiopulmonary Arrest (from a Japanese Multicenter Registry)

Abstract

Details on the characteristics and outcomes in patients with acute coronary syndrome (ACS) complicated with cardiopulmonary arrest (CPA) have been limited. We evaluated inhospital outcomes after percutaneous coronary intervention in these patients. From 2008 to 2014, 5,943 patients with ACS including 2,973 patients with ST-elevation myocardial infarction (STEMI) and 2,970 patients with non-STEMI or unstable angina (NSTE-ACS) were registered. In total, 264 patients experienced CPA within 24 hours of admission. Patients with CPA presented more frequently with cardiogenic shock (CS) (79.0% vs 7.7% in STEMI; 78.0% vs 1.1% in NSTE-ACS; p <0.001, respectively) and had a higher mortality rate (26.2% vs 3.8% in STEMI; 36.0% vs 1.6% in NSTE-ACS; p <0.001, respectively) than those without. On multivariate analysis, both age (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.02 to 1.07, p = 0.002) and presence of CS (OR 5.54, 95% CI 2.19 to 17.13, p <0.001) were independent predictors of inhospital mortality in patients with ACS complicated with CPA and adjusted ORs increased exponentially under the presence of these variables (age ≥75 years: OR 3.16, 95% CI 2.14 to 4.70; CS: OR 18.70, 95% CI 12.40 to 28.40; presence of both these factors: OR 33.80, 95% CI 21.13 to 54.23). In conclusion, the mortality rate after percutaneous coronary intervention remains high in patients with ACS complicated with CPA. Older age and shock status were strongly associated with inhospital mortality in these patients.