Abstract / Summary
Background: Out-of-hospital cardiac arrest (OHCA) is a severe manifestation of acute ST-elevation myocardial infarction (STEMI). Although several studies have investigated factors associated with OHCA, the findings have been inconsistent. This study evaluates the clinical and angiographic factors associated with OHCA in STEMI patients undergoing primary percutaneous coronary intervention (PCI).
Methods: This retrospective study included consecutive STEMI patients undergoing primary PCI at Rambam Health Care Campus between 2010 and 2024. Patients were categorized by the presence of pre-hospital OHCA. Clinical and angiographic characteristics were compared, and logistic regression was used to identify independent predictors of OHCA.
Results: Among 2,176 STEMI patients undergoing primary PCI, 135 (6.2%) experienced pre-hospital OHCA. OHCA patients were younger and had higher serum creatinine levels. The distribution of the IRA differed significantly (p=0.005): LMCA and LAD were more frequently the infarct-related arteries, whereas RCA involvement was less common. Independent predictors of OHCA were LMCA (OR 6.03), LAD (OR 1.81), and higher creatinine (OR 1.44). Age and smoking were inversely associated with OHCA (OR 0.97 per additional year, and OR 0.62, respectively). Lesion location, initial TIMI flow, and extent of coronary artery disease were not associated with OHCA.
Conclusions: Patients with OHCA in the setting of STEMI are younger, have higher creatinine levels, and more often have culprit lesions in the LMCA or LAD. These findings suggest that specific anatomic and metabolic factors, rather than overall coronary disease burden, are associated with pre-hospital cardiac arrest.