Impact of Pre-Revascularization and Post-Revascularization Cardiac Arrest on Survival Prognosis in Patients With Acute Myocardial Infarction and Following Emergency Percutaneous Coronary Intervention

Objectives To evaluate the effects of the occurrence and timing of sudden cardiac arrest (SCA) on survival of acute myocardial infarction (AMI) patients who underwent emergency percutaneous coronary intervention (PCI). Methods We analyzed 1956 consecutive AMI patients with emergency PCI from 2014 to 2018. Patients with cardiac arrest events were identified and their medical records were reviewed. Results Patients were divided into non-cardiac arrest group (NCA group, n=1724), pre-revascularization cardiac arrest (PRCA group, n=175) and post-revascularization SCA (POCA group, n=57) according to SCA timing. Compared to NCA group, PRCA group and POCA group presented with higher brain natriuretic polypeptide (BNP), more often Killip class 3/4, atrial fibrillation and less often completed recovery of coronary artery perfusion (all p<0.05). Both PRCA and POCA patients showed increased 30-day all-cause mortality compared to NCA patients (8.0% and 70.2% vs. 2.9%, both p<0.001). However, as compared to NCA, PRCA did not lead to higher mortality during long-term follow-up (median time 917 days) (16.3% vs. 18.6%, p=0.441), whereas POCA were associated with increased all-cause mortality (36.3% vs. 18.6%, p<0.001). Multivariate analysis identified Killip class 3/4, atrial fibrillation, high maxium MB isoenzyme of creatinine kinase and high creatinine as predictive factors for POCA. In Cox regression analysis, POCA was found as a strong mortality-increase predictor (HR, 8.87; 95% CI, 2.26-34.72; p=0.002) for long-term all-cause death. Conclusions POCA appeared to be a strong life-threatening factor for 30-day and long-term all-cause mortality among AMI patients who admitted alive and underwent emergency PCI. However, PRCA experience did not lead to a poorer long-term survival in 30-day survivors.