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Original research
Association of left anterior descending artery involvement on clinical outcomes among patients with STEMI presenting with and without out-of-hospital cardiac arrest
  1. Mia Bertic1,
  2. Christopher B Fordyce1,
  3. Nima Moghaddam1,
  4. John Cairns1,
  5. Martha Mackay2,
  6. Joel Singer3,
  7. Terry Lee3,
  8. Michele Perry-Arnesen4,
  9. Wendy Tocher4 and
  10. Graham Wong1
  1. 1Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
  2. 2Department of Medicine, Providence Health Care, Vancouver, British Columbia, Canada
  3. 3Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital and University of British Columbia, Vancouver, British Columbia, Canada
  4. 4Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Graham Wong; gcwong{at}mail.ubc.ca

Abstract

Background ST-segment elevation myocardial infarction (STEMI) outcomes are influenced by the location of the culprit vessel with worse outcomes portended with a left anterior descending (LAD) culprit lesion. However, relatively little is known about the independent association of LAD involvement with clinical outcomes of patients with STEMI with and without out-of-hospital cardiac arrest (OHCA).

Methods We identified 91 patients with and 929 without a preceding OHCA within the Vancouver Coastal Health Authority who presented with an acute STEMI and underwent primary percutaneous coronary intervention between 26 June 2007 and 31 March 2016.

Results Patients with STEMI with OHCA had higher rates of in-hospital cardiac arrest (43.3% vs 8.3%, p<0.001), heart failure (50.5% vs 11.3%, p<0.001), cardiogenic shock (49.5% vs 5.7%, p<0.001), mortality (35.2% vs 3.3%, p<0.001) and reduced left ventricular ejection fraction (LVEF; 42.9% vs 47.3%, p<0.001) compared with those without OHCA. Among patients without OHCA, LAD involvement was associated with increased heart failure (18.1% vs 5.2%, p<0.001), in-hospital cardiac arrest (10.7% vs 6.2%, p<0.014), cardiogenic shock (8.4% vs 3.3%, p<0.001), reduced LVEF (43.0% vs 51.2%, p<0.001) and mortality (5.2% vs 1.3%, p=0.003) compared with patients without LAD involvement. With the exception of LVEF, these associations were not seen among patients with STEMI with OHCA and an LAD culprit. The presence of an LAD culprit was not independently associated with increased hospital mortality among patients with OHCA after adjusting for potential confounding factors.

Conclusion Our study has demonstrated a differential impact of LAD involvement on clinical outcomes among patients with STEMI who present with and without OHCA. Our data highlight the complexity surrounding the prognostication following OHCA complicating STEMI and demonstrate that other mechanisms other than LAD involvement contribute to the high mortality associated with OHCA as a result of STEMI.

  • resuscitation
  • sudden cardiac death
  • coronary artery disease
  • coronary intervention (PCI)
http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Twitter @nimamogh

  • Contributors GW, CBF and MB conceived the paper and drafted the article. All authors contributed to the data analysis and interpretation. All authors were involved in the critical revision of the article and the final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the University of British Columbia Clinical Research Ethics Board (H17-00375).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article or uploaded as supplementary information.

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