Cardiac Arrest as Presenting Symptom in ST-Segment Elevation Acute Coronary Syndrome. Data From The ARGEN-IAM-ST Registry

pp. 433-438

Abstract

Background: Cardiac arrest (CA) in the context of acute coronary syndrome is a major cause of out-of-hospital and in-hospital death. Some patients present CA as the initial manifestation of the condition, and although almost half of them do not reach healthcare centers and die, others may be hospitalized.

Objectives: The aim of this study was to describe the prevalence of CA as a presenting symptom in ST-segment elevation myocardial infarction, and analyze the characteristics of these patients, treatment, and in-hospital mortality.

Methods: We conducted a retrospective analysis of patients included in the ARGEN-IAM-ST registry. Data regarding patients' characteristics, reperfusion strategies, and in-hospital outcomes were collected. The Redcap case record form has an item called "presenting symptoms" where physicians check the Killip and Kimball (KK) class on admission and the presence (yes box) or absence (no box) of CA. Cardiac arrest was defined as the sudden cessation of cardiac activity that can lead to death if resuscitation measures are not taken or if they are unsuccessful.

Results: A total of 7505 patients were included between March 2014 and April 2025. Cardiac arrest was the presenting symptom in 7.5% of cases (n = 564). Patients presenting with CA were older (median age 62 vs. 61 years) and had a higher prevalence of diabetes (32.8% vs. 26.8%), hypertension (61% vs. 53.5%), history of coronary artery disease (16.5% vs. 14.9%), chronic obstructive pulmonary disease (4.8% vs. 2.9%), and peripheral vascular disease (2.1% vs. 1.1%), with statistically significant differences in all cases. On coronary angiography, left main coronary artery disease (6.7% vs. 0.9%, p <0.001), left anterior descending coronary artery disease (48.6% vs. 47.6%, p <0.001), and multivessel disease (32.3% vs. 29.5%, p=0.004) were mostly common. Patients with CA as presenting symptom were less likely to receive reperfusion therapy (85.2% vs. 90.9%, p<0.001) and primary percutaneous coronary intervention (PCI) 67.9% vs. 75.2%, p=0.014). There were no differences in door-to-balloon time among those undergoing PCI. In patients with CA as the presenting symptom, 48.6% were in KK class D on admission. The use of mechanical ventilation (MV) was 50.4% vs. 5.1% (p<0.001). In patients with CA on admission, in-hospital mortality was 50.5% versus 4.6% (p<0.001). Mortality in patients with KK class D and CA on admission was 71%, and 36% in KK class D patients without CA (p <0.001). In multivariate analysis, diabetes and KK D were independent predictors of CA.

Conclusion: One out of 7 STEMI patients arrives at a healthcare center with CA as the presenting symptom. These patients exhibit an elevated risk profile, are less likely to receive reperfusion treatment and exhibit an increased incidence of heart failure, shock, and requirements of MV. Half of the patients presenting with CA die during hospitalization. This figure rises to 7 out of 10 if the patient also has cardiogenic shock on admission. Training staff in cardiopulmonary resuscitation (CPR) and post-cardiac arrest management is essential to reducing mortality.