title: Prognostic implication of out-of-hospital cardiac arrest in patients with cardiogenic shock and acute myocardial infarction.
abstract: OBJECTIVE
  To compare outcome in patients with acute myocardial infarction (MI) and cardiogenic shock (CS) presenting with and without out-of-hospital cardiac arrest (OHCA).
  
  
  BACKGROUND
  Despite general improvement in outcome after acute MI, CS remains a leading cause of death in acute MI patients with a high 30-day mortality rate. OHCA on top of cardiogenic shock may further increase mortality in these patients resulting in premature withdrawal of supportive therapy, but this is not known.
  
  
  RESULTS
  In a retrospective study from 2008 to 2013, 248 consecutive patients admitted alive to a tertiary centre with the diagnosis of CS and acute MI were enrolled, 118 (48%) presented with OHCA and 130 (52%) without (non-OHCA patients). Mean lactate level at admission was significantly higher in OHCA patients compared with non-OCHA patients (9mmol/l (SD 6) vs. 6mmol/l (SD 4) p<0.0001). Co-morbidities were more prevalent in the non-OHCA group. By univariate analysis age (Hazard ratio (HR)=1.02 [CI 1.00-1.03], p=0.01) and lactate at admission (HR=1.06 [CI 1.03-1.09], p<0.001), but not OHCA (HR=1.1 [CI 0.8-1.4], p=NS) was associated with mortality. In multivariate analysis, only age (HR=1.02 [CI 1.01-1.04], p=0.003) and lactate level at admission (HR=1.06 [1.03-1.09], p<0.001) were independent predictors of mortality. One-week mortality was 63% in the OHCA group and 56% in the non-OHCA group, p=NS.
  
  
  CONCLUSIONS
  OHCA is not an independent predictor of mortality in patients with acute MI complicated by cardiogenic shock. This should encourage active intensive treatment of CS patients regardless of OHCA.
authors.affiliation: Department of Thoracic Anaesthesia, The Heart Centre, Rigshospitalet - Copenhagen University Hospital, Denmark. Electronic address: sarahostenfeld@hotmail.com.
authors.forename: Sarah
authors.initials: S
authors.lastname: Ostenfeld
authors.affiliation: Department of Cardiology, The Heart Centre, Rigshospitalet - Copenhagen University Hospital, Denmark.
authors.forename: Matias Greve
authors.initials: MG
authors.lastname: Lindholm
authors.affiliation: Department of Cardiology, The Heart Centre, Rigshospitalet - Copenhagen University Hospital, Denmark.
authors.forename: Jesper
authors.initials: J
authors.lastname: Kjaergaard
authors.affiliation: Department of Cardiology, The Heart Centre, Rigshospitalet - Copenhagen University Hospital, Denmark.
authors.forename: John
authors.initials: J
authors.lastname: Bro-Jeppesen
authors.affiliation: Department of Cardiology, Odense University Hospital, Denmark.
authors.forename: Jacob Eifer
authors.initials: JE
authors.lastname: Møller
authors.affiliation: Department of Thoracic Anaesthesia, The Heart Centre, Rigshospitalet - Copenhagen University Hospital, Denmark.
authors.forename: Michael
authors.initials: M
authors.lastname: Wanscher
authors.affiliation: Department of Cardiology, The Heart Centre, Rigshospitalet - Copenhagen University Hospital, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Hassager
mesh_terms: D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D058687:Out-of-Hospital Cardiac Arrest / Q000209:etiology / Q000401:mortality; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000209:etiology*; D016019:Survival Analysis
chemical_list: D019344:Lactic Acid
keywords: Cardiac arrest; Cardiogenic shock; Ischaemia; Lactate; Mortality