{
  "abstract": "Introduction Acute myocardial infarction is a leading cause of out-of-hospital cardiac arrest in adults. We aimed to characterise all-cause mortality and its associated factors in resuscitated cardiac arrest patients with ST-elevation myocardial infarction (STEMI) presenting to an Irish designated primary percutaneous coronary intervention (PPCI) centre over a five-year period.Methods A retrospective observational study was performed including patients resuscitated from a cardiac arrest with a STEMI ECG accepted to St James’s Hospital for PPCI between January 2020 and January 2025. Data regarding patient demographics, comorbidities, hospital admission, and STEMI metrics were analysed. Patients with non-ischaemic aetiology were excluded.Results 163 patients were diagnosed with STEMI complicated by cardiac arrest ( table 1). The median age was 62 years (IQR 55–69). 30-day all-cause mortality was 29.4%. 57.7% of patients received PPCI within the target time of <120 minutes from first ECG [median 109.5 (IQR 74.25–150) minutes] (table 2). Patients who achieved reperfusion within 120 minutes had significantly lower 30-day all-cause mortality compared to those delayed (21.0% vs 42.4%, OR 0.36, 95% CI: 0.17–0.76, p=0.006). 30-day all-cause mortality was significantly higher in patients with an initial pH <7.2 (62.5% vs 14.7%, OR 9.67, 95% CI: 3.08–30.37, p<0.001), initial non-shockable rhythm (76.9% vs 25.5%, OR 9.73, 95% CI: 2.54–37.28, p<0.001), prolonged CPR >30 minutes (66.7% vs 21.9%, OR 7.14, 95% CI: 2.63–19.40, p<0.001), unwitnessed arrest (61.5% vs 26.1%, OR 4.53, 95% CI: 1.39–14.76, p=0.007), and those requiring intubation (43.5% vs 11.6%, OR 5.87, 95% CI: 2.52–13.65, p<0.001).Conclusion Short-term mortality in cardiac arrest patients with STEMI was considerable and may be predicted by certain clinical features. Low pH, non-shockable rhythm, prolonged or unwitnessed arrest, and need for intubation were all associated with poor outcomes. Our analysis showed that timely reperfusion was associated with better outcomes in this cohort.Abstract 57 Table 1Patient characteristics (n=163). Continuous results are expressed as a median (with interquartile range), and categorical variables are expressed as a total (with percentage)Age 62 (55–69) Male 133 (81.6%) Length-of-stay (days) 4 (1–10) ROSC prior to arrival at PPCI centre 150 (92%) Arrival mode Ambulance direct from community 98 (60.1%) - OOHCA - 91 (55.8%) - Cardiac arrest in PPCI centre ED - 7 (4.3%) Transferred from other hospital 61 (37.4%) - OOHCA - 53 (32.5%) - Cardiac arrest in other ED - 8 (4.9%) Self-presented 4 (2.5%) Comorbidities Smoking history (current or former) 93 (57.1%) Dyslipidaemia 62 (38%) Hypertension 46 (28.2%) Diabetes mellitus 20 (12.3%) Prior PCI or CABG 12 (7.4%) Prior myocardial infarction 5 (3.1%) Prior peripheral arterial disease 3 (1.8%) Prior cerebrovascular disease 6 (3.7%) Prognostic indicators Unwitnessed arrest 13 (8%) Initial non-shockable rhythm 13 (8%) No bystander CPR 4 (2.5%) >30 minutes to ROSC 22 (13.5%) Initial pH <7.2 40 (24.5%) Initial lactate >7.0 mmol/L 21 (12.9%) Initial lactate level (mmol/L) 4.9 (3.12–8.32) Intubated for GCS post-ROSC 94 (57.7%) All-cause mortality In-hospital mortality 48 (29.4%) 30-day mortality 48 (29.4%) ROSC = Return Of Spontaneous Circulation, PPCI = Primary Percutaneous Coronary Intervention, OOHCA = Out-Of-Hospital Cardiac Arrest, ED = Emergency Department, CABG = Coronary Artery Bypass Graft, MI = Myocardial Infarction, CPR = Cardiopulmonary Resuscitation, GCS = Glasgow Coma ScaleAbstract 57 Table 2STEMI metrics and angiographic features (n=163). Continuous results are expressed as a median (with interquartile range), and categorical variables are expressed as a total (with percentage) ECG STEMI151 (92.6%) LBBB2 (1.2%) Other10 (6.1%) Cardiac catheterisation metrics ECG-to-Reperfusion time (minutes)109.5 (74.25–150) ECG-to-Reperfusion time ≤ 120 minutes82/142 (57.7%) Door-to-Balloon time (minutes)73.5 (36–135.75) Infarct-related artery Right coronary artery39 (23.9%) Left main coronary artery7 (4.3%) Left anterior descending artery79 (48.5%) Left circumflex artery29 (17.8%) No culprit identified9 (5.4%) - Chronic total occlusion without culprit - 4 (2.4%) - Triple vessel disease without culprit - 2 (1.2%) - Emergency angiography not performed - 3 (1.8%)STEMI = ST-Elevation Myocardial Infarction, LBBB = Left Bundle Branch Block, ECG = Electrocardiogram",
  "authors": [
    {
      "affiliations": [
        "St James’s Hospital, Dublin, Ireland"
      ],
      "name": "R Karlsson"
    },
    {
      "affiliations": [
        "St James’s Hospital, Dublin, Ireland"
      ],
      "name": "M Waters"
    },
    {
      "affiliations": [
        "St James’s Hospital, Dublin, Ireland"
      ],
      "name": "I Pearson"
    }
  ],
  "title": "57 Factors associated with all-cause mortality in STEMI complicated by cardiac arrest at a tertiary cardiology centre",
  "uid": "a9585549-8abf-543e-96ba-bf9fa4053b7f"
}