Impact of a territorial ST-segment elevation myocardial infarction network on prognosis of patients with out-of-hospital cardiac arrest

Abstract

Introduction: We sought to assess the effect of a territorial system of care for ST-elevation myocardial infarction (STEMI) on the outcome of out-of-hospital cardiac arrest (OOHCA). Materials and Methods: We enrolled 720 patients who experienced a witnessed OOHCA of presumed cardiac origin during a four-year period in an area with a STEMI network and for whom resuscitation was attempted. Results: Overall, 242 (33.6%) patients had return of spontaneous circulation (ROSC), 645 (90%) died before discharge. We observed a trend toward decreased overall mortality for OOHCA between the years 2004 and 2007, both in the entire population and in patients with ROSC (2004=94%; 2005=89%; 2006=85%; 2007=89%; P=0.064; 2004=81%; 2005=69%; 2006=65%; 2007=60%; P=0.076, respectively). On multivariable analysis, age, crew-witnessed arrest and presence of shockable rhythm were independent predictors of mortality. Patients who experienced OOHCA in the year 2006 (OR=0.47; 95% CI: 0.21–1.05; P=0.07) and 2007 (OR=0.51; 95% CI: 0.23–1.12; P=0.09) showed a strong trend toward decreased risk of mortality compared to year 2004. In patients with ROSC, the year 2007 was associated with a significant lower risk of mortality compared to year 2004 (OR=0.38; 95% CI: 0.15–0.96; P=0.04).

Conclusions: Implementation of a territorial network of care for STEMI appears to be associated with reduced mortality OOHCA patients.

Keywords::

• Cardiac arrest
• myocardial infarction
• territorial system of care

Acknowledgements

The authors are grateful to Dr Valentina Ovi who performed a careful quality data monitoring.

Declaration of interest: The authors report on conflicts of interest. The authors alone are responsible for the content and writing of the paper.