# The Association between Cardiac Arrest and Mortality in Patients with Acute Myocardial Infarction Complicated by Cardiogenic Shock

## TL;DR

This study finds that cardiac arrest at admission does not significantly affect survival in patients with heart attacks complicated by cardiogenic shock.

## Contribution

The study provides new evidence that cardiac arrest at admission is not a significant predictor of mortality in AMI-CS patients.

## Key findings

- Cardiac arrest at admission was not a significant risk factor for 30-day or 1-year mortality in AMI-CS patients.
- The IABP-SHOCK II score showed better predictive performance than the GRACE score for mortality in these patients.
- Adding cardiac arrest status did not improve the predictive value of the IABP-SHOCK II score.

## Abstract

The impact of cardiac arrest (CA) at admission on the
prognosis of patients with acute myocardial infarction (AMI) complicated by
cardiogenic shock (CS) remains a subject of debate.

We
conducted a retrospective study at West China Hospital from 2018 to 2021,
enrolling 247 patients with AMI complicated by CS (AMI-CS). Patients were
categorized into CA and non-CA groups based on their admission status. Univariate
and multivariate Cox regression analyses were performed, with 30-day and 1-year
mortality as the primary endpoints. Kaplan–Meier plots were constructed, and
concordance (C)-indices of the Global Registry of Acute Coronary Event (GRACE)
score, Intra-aortic Balloon Pump in Cardiogenic Shock (IABP-SHOCK) II score, and
IABP-SHOCK II score with CA were calculated.

Among the enrolled
patients, 39 experienced CA and received cardiopulmonary resuscitation at
admission. The 30-day and 1-year mortality rates were 40.9% and 47.0%,
respectively. Neither univariate nor multivariate Cox regression analyses
identified CA as a significant risk factor for 30-day and 1-year mortality. In
C-statistics, the GRACE score exhibited a moderate effect (C-indices were 0.69
and 0.67, respectively), while the IABP-SHOCK II score had a better predictive
performance (C-indices were 0.79 and 0.76, respectively) for the 30-day and
1-year mortality. Furthermore, CA did not enhance the predictive value of the
IABP-SHOCK II score for 30-day (p = 0.864) and 1-year mortality
(p = 0.888).

Cardiac arrest at admission did not
influence the survival of patients with AMI-CS. Active resuscitation should be
prioritized for patients with AMI-CS, regardless of the presence of cardiac
arrest.