Outcomes of Aggressive Management in Acute Coronary Syndrome Patients Surviving Sudden Cardiac Arrest

Abstract

Objectives: Patients with acute coronary syndrome (ACS) who survive sudden cardiac arrest (SCA) face a high risk of mortality and complications. This study aims to evaluate the outcomes of aggressive management strategies in this high-risk population. Methodology: This prospective observational cohort study was conducted at the National Institute of Cardiovascular Diseases (NICVD) over six months (June 2021 to December 2021). It included ACS patients who survived SCA and underwent coronary angiography with or without percutaneous coronary intervention (PCI). Baseline characteristics, demographic details, clinical presentations, electrocardiographic, echocardiographic, and angiographic findings were collected alongside in-hospital outcomes. Results: A total of 97 patients were enrolled, including 82 with STEMI and 15 with NSTE-ACS. The majority (55.7%, n=54) presented with tachyarrhythmic SCA, while 35.1% (n=34) had bradyarrhythmic SCA. The mean age was 56.3 ± 11.9 years, and 72.2% (n=70) were male. Severe left ventricular (LV) dysfunction (EF 15-35%) was observed in 43.3% (n=42). The immediate in-hospital mortality rate was 10.3% (n=10), while complications included hypoxic-ischemic encephalopathy (14.4%, n=14), cardiogenic shock (12.4%, n=12), and multi-organ failure (6.2%, n=6). Patients with a history of myocardial infarction (MI) had a significantly higher mortality risk (OR: 4.8, 95% CI: 1.2-18.7). However, no specific clinical factor emerged as an independent predictor of mortality in multivariable analysis. Conclusion: ACS patients who survive SCA remain at high risk of mortality. However, aggressive management, including timely resuscitation and invasive interventions, resulted in survival without major complications in more than half of the patients. Future case-control studies are needed to compare outcomes between aggressive and conservative management strategies.