The clinical characteristics of in-hospital cardiac arrest in patients with acute myocardial infarction complicated with cardiogenic shock and its impact on the risk of death

Zhang Jing; Shao Chengcheng; Zhu Jiajia; Li Jiang; Wang Liangshan; Chen Liying

doi:10.3760/j.issn.1673-4777.2025.10.004

Abstract：Objective To observe the clinical characteristics of in-hospital cardiac arrest(IHCA)in patients with acute myocardial infarction complicated with cardiogenic shock,and further analyze the risk of in-hospital death and discharge death after IHCA.Methods Consecutive patients with acute myocardial infarction complicated with cardiogenic shock admitted to the Critical Care Center,Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University from September 1,2021 to July 31,2024 were enrolled,and the patients who met the inclusion criteria were enrolled in a pure observational study.Patients were divided into groups according to whether IHCA events occurred during the treatment,and the clinical outcomes and clinical characteristics of patients in different groups were further observed and compared.The primary endpoint was in-hospital death.The secondary endpoints included in-hospital complications,all-cause death within 30 d after discharge and all-cause death within 1 year after discharge.Cox regression model was used to analyze the relationship between IHCA and the risk of in-hospital death,and modified Poisson regression was used to analyze the effect of IHCA on death at 30 d and 1 year after discharge.Results A total of 148 patients were selected in this study,of which 62 patients had IHCA(IHCA group),the incidence of IHCA was 41.9％,and the remaining 86 patients were included in the non-IHCA group.The proportion of male,blood lactate level,vasoactive drug score and gastrointestinal bleeding rate in IHCA group were significantly higher than those in non-IHCA group,and the left ventricular ejection fraction(LVEF)and the proportion of revascularization were significantly lower than those in non-IHCA group(all P＜0.05).The in-hospital mortality,30 d mortality,and 1-year mortality in the IHCA group were significantly higher than those in the non-IHCA group(all P＜0.05).Sixty-two IHCA patients were divided into shockable cardiac arrest(VFCA)group(47 cases)and non-shockable cardiac arrest(NVFCA)group(15 cases)according to the type of cardiac arrest.The 30 d mortality rate in the NVFCA group was significantly higher than that in the VFCA group(P＜0.05).Cox regression model analysis showed that compared with the non-IHCA group,the hazard ratio of in-hospital death in the IHCA group was 2.064(P=0.011).The results of modified Poisson regression analysis showed that compared with the non-IHCA group,the relative risk of death in the IHCA group was 1.606(P=0.003)at 30 d after discharge and 1.644(P=0.001)at 1 year after discharge.Compared with the VFCA group,the relative risk of death in the NVFCA group was 1.599(P=0.010)at 30 d after discharge and 1.369(P=0.070)at 1 year after discharge.Conclusion In patients with acute myocardial infarction complicated with cardiogenic shock,blood lactate level is higher,LVEF level and revascularization rate are lower in IHCA patients.IHCA increased the risk of in-hospital death,30 d death and 1-year death after discharge,and NVFCA increased the risk of 30 d death after discharge.