ArticleInternal and emergency medicine2026
The IHCA paradox: high early mortality, yet comparable long-term survival in STEMI patients.
Article in Internal and emergency medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
In-hospital cardiac arrest in STEMI (STEMI-IHCA) patients poses a formidable mortality risk, yet comprehensive survival data remain scarce. This study compared clinical characteristics and outcomes of STEMI-IHCA versus non-cardiac arrest (non-CA) patients. A cohort of 3311 STEMI patients, treated in the Cath lab and transferred to the intensive cardiac care unit, was retrospectively analyzed over a 21-year period (2003-2024). Of these, 208 (6.3%) had experienced STEMI-IHCA. The mean age was 66.2 ± 12.6 years; 77.8% were male. STEMI-IHCA patients more frequently had peripheral artery disease, multivessel disease, and renal impairment. In contrast, non-CA patients had higher rates of dyslipidemia and smoking. A striking 72.7% of STEMI-IHCA cases presented with a shockable rhythm, achieving rapid ROSC (< 1 min).Despite this, in-hospital mortality for STEMI-IHCA was drastically higher (25.5 vs. 2.8% for non-CA, p < 0.01), with most deaths occurring within three days (66 vs. 44.2%, p < 0.01). Predictors of in-hospital mortality were IHCA, older age, peripheral artery disease, reduced LVEF, and higher TIMI risk index. Among patients discharged alive, long-term mortality over a 96-month follow-up was similar between STEMI-IHCA and non-CA patients (36.8 vs. 33.3%, p = 0.37), confirmed by Kaplan-Meier analysis (p = 0.73) as well. Our findings confirm the high risk of in-hospital mortality risk associated with STEMI-IHCA. Nevertheless, among patients discharged alive, particularly with rapid ROSC, the long-term prognosis can align remarkably with that of STEMI patients who did not experience IHCA. This underscores the critical importance of prompt intervention as a powerful determinant of favorable long-term outcomes.
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