Prehospital survival of patients with ST-elevation myocardial infarction requiring out-of-hospital cardiopulmonary resuscitation - a nationwide, real-world observational study
Abstract Background The mortality risk of patients presenting with ST-elevation myocardial infarction (STEMI) has been extensively researched. Even though STEMI can be diagnosed before hospital admission, prehospital mortality has been less frequently studied. We aimed to analyze the outcomes of pat...
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BMC
2025-07-01
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| Series: | BMC Emergency Medicine |
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| Online Access: | https://doi.org/10.1186/s12873-025-01292-y |
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| author | Dominika Szabó András Szabó Andrea Székely |
| author_facet | Dominika Szabó András Szabó Andrea Székely |
| author_sort | Dominika Szabó |
| collection | DOAJ |
| description | Abstract Background The mortality risk of patients presenting with ST-elevation myocardial infarction (STEMI) has been extensively researched. Even though STEMI can be diagnosed before hospital admission, prehospital mortality has been less frequently studied. We aimed to analyze the outcomes of patients with STEMI requiring out-of-hospital cardiopulmonary resuscitation (CPR). Methods From a large, nationwide prehospital case report database, we collected data from 668 patients requiring CPR because of ambulance-witnessed OHCA (out-of-hospital cardiac arrest) who were diagnosed with STEMI by ECG before cardiac arrest. Utstein-style consensus reporting guidelines were followed. The endpoint was hospital admission with spontaneous circulation. In addition to descriptive statistics, we also aimed to identify predictors of the outcome using multivariable logistic regression. Model performance was characterized by c-statistics and multiple fitting methods. Internal validation was performed using calibration intercept and slope. Results Using CPR initial rhythm, age, initial heart rate, initial systolic blood pressure, and ECG localization of STEMI as predictors, we found that the constructed logistic regression model showed good discriminative ability, with a c-statistic of 0.844 (95% CI = 0.8105–0.8787). The overall model fit was good, with Hosmer & Lemeshow p = 0.979. The value of Nagelkerke R2 test of 0.445 indicated a strong relationship between predictors and outcome. The Z-value of calibration slope was relative to slope = 1 (95% CI = 0.85–1.16). Conclusions This model can be used to estimate the probability of hospital admission following resuscitation due to ambulance-witnessed OHCA in patients with STEMI. Further studies are needed to improve the possibility of definitive in-hospital treatment for a better survival rate. Clinical trial number Not applicable. |
| format | Article |
| id | doaj-art-43fd701b7fe04695b3e553888854d14f |
| institution | Kabale University |
| issn | 1471-227X |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Emergency Medicine |
| spelling | doaj-art-43fd701b7fe04695b3e553888854d14f2025-08-20T03:45:52ZengBMCBMC Emergency Medicine1471-227X2025-07-012511810.1186/s12873-025-01292-yPrehospital survival of patients with ST-elevation myocardial infarction requiring out-of-hospital cardiopulmonary resuscitation - a nationwide, real-world observational studyDominika Szabó0András Szabó1Andrea Székely2Doctoral College, Semmelweis UniversityNational Ambulance ServiceDepartment of Oxiology and Emergency Medicine, Semmelweis UniversityAbstract Background The mortality risk of patients presenting with ST-elevation myocardial infarction (STEMI) has been extensively researched. Even though STEMI can be diagnosed before hospital admission, prehospital mortality has been less frequently studied. We aimed to analyze the outcomes of patients with STEMI requiring out-of-hospital cardiopulmonary resuscitation (CPR). Methods From a large, nationwide prehospital case report database, we collected data from 668 patients requiring CPR because of ambulance-witnessed OHCA (out-of-hospital cardiac arrest) who were diagnosed with STEMI by ECG before cardiac arrest. Utstein-style consensus reporting guidelines were followed. The endpoint was hospital admission with spontaneous circulation. In addition to descriptive statistics, we also aimed to identify predictors of the outcome using multivariable logistic regression. Model performance was characterized by c-statistics and multiple fitting methods. Internal validation was performed using calibration intercept and slope. Results Using CPR initial rhythm, age, initial heart rate, initial systolic blood pressure, and ECG localization of STEMI as predictors, we found that the constructed logistic regression model showed good discriminative ability, with a c-statistic of 0.844 (95% CI = 0.8105–0.8787). The overall model fit was good, with Hosmer & Lemeshow p = 0.979. The value of Nagelkerke R2 test of 0.445 indicated a strong relationship between predictors and outcome. The Z-value of calibration slope was relative to slope = 1 (95% CI = 0.85–1.16). Conclusions This model can be used to estimate the probability of hospital admission following resuscitation due to ambulance-witnessed OHCA in patients with STEMI. Further studies are needed to improve the possibility of definitive in-hospital treatment for a better survival rate. Clinical trial number Not applicable.https://doi.org/10.1186/s12873-025-01292-ySTEMIOHCACPRPrehospital survivalInitial rhythm |
| spellingShingle | Dominika Szabó András Szabó Andrea Székely Prehospital survival of patients with ST-elevation myocardial infarction requiring out-of-hospital cardiopulmonary resuscitation - a nationwide, real-world observational study BMC Emergency Medicine STEMI OHCA CPR Prehospital survival Initial rhythm |
| title | Prehospital survival of patients with ST-elevation myocardial infarction requiring out-of-hospital cardiopulmonary resuscitation - a nationwide, real-world observational study |
| title_full | Prehospital survival of patients with ST-elevation myocardial infarction requiring out-of-hospital cardiopulmonary resuscitation - a nationwide, real-world observational study |
| title_fullStr | Prehospital survival of patients with ST-elevation myocardial infarction requiring out-of-hospital cardiopulmonary resuscitation - a nationwide, real-world observational study |
| title_full_unstemmed | Prehospital survival of patients with ST-elevation myocardial infarction requiring out-of-hospital cardiopulmonary resuscitation - a nationwide, real-world observational study |
| title_short | Prehospital survival of patients with ST-elevation myocardial infarction requiring out-of-hospital cardiopulmonary resuscitation - a nationwide, real-world observational study |
| title_sort | prehospital survival of patients with st elevation myocardial infarction requiring out of hospital cardiopulmonary resuscitation a nationwide real world observational study |
| topic | STEMI OHCA CPR Prehospital survival Initial rhythm |
| url | https://doi.org/10.1186/s12873-025-01292-y |
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