Abstract 4141883: The out-of-hospital cardiac arrest in patients with acute myocardial infarction and pre-existing aortic stenosis.

Background: Pre-existing significant aortic stenosis (sAS) in patients with out-of-hospital cardiac arrest (OHCA) may lead to ineffective chest compressions due to the pathophysiology and hemodynamics of stenosis, reducing the probability of return of spontaneous circulation, and the resuscitation may be complicated. Aim: To analyze the influence of sAS on the risk of OHCA in patients with acute myocardial infarction (AMI-OHCA), on the complicity of resuscitation and survival. Methods: The analysis was based on the national all-comers’ registry of coronary interventions enriched by information from the National Registry of Reimbursed Health Services and the Registry of Deaths. Complicity of resuscitation was defined as the necessity of mechanical ventilation up to hospital admission. The association between AS, patient characteristics and mortality was analyzed using logistic regression, multivariate model was used for adjusting for co-founders. Results: Our dataset included all patients with AMI-OHCA in the country in the period from 2017 to 2021 (N=4,414), of whom 1.8% (N=80) patients had pre-existing sAS and were followed up at the medical institutions (Table 1). The incidence of sAS was 1.7% in those who suffered OHCA and 1.8% in AMI patients without this complication, p=0.66 . The AMI-OHCA patients were divided into three groups – those who died during OHCA (N=238, sAS in 4.2%), those who were admitted after OHCA on mechanical ventilation (N=3,255, sAS in 1.8%), and spontaneously ventilating patients (N=921, sAS in 1.2%). Multivariate analysis showed that sAS was not recognized as a risk factor for the use of mechanical ventilation in AMI-OHCA patients, odds ratio (OR) 1.61 (95%CI 0.83;3.09), p=0.16, however sAS presents a significant risk of pre-hospital mortality of AMI-OHCA patients, multivariate OR 3.4 (95%CI 1.20;9.58), p= 0.02. Additionally, the in-hospital, 30-day, and long-term prognosis of AMI patients after OHCA is adversely affected by AS with odds ratio of 2.47 (95%CI 1.38;4.41), 2.83 (95%CI 1.61;4.95), and 1.81 (95%CI 1.38;2.38) vs. non-VHD respectively. Conclusion: Pre-existing sAS has a significant adverse influence on the survival of AMI-OHCA patients and is a significant risk factor of pre-hospital mortality. Therefore, patients with AS should be carefully screened for coronary artery disease, antithrombotic therapy should be considered, and the earlier planning of valvular intervention after AMI should be evaluated.