Abstract Body: Background: Coronary artery disease is a common cause of out-of-hospital cardiac arrest (OHCA). Early recognition myocardial infarction (MI) and initiating appropriate therapy has been shown to improve outcomes in OHCA. While early coronary intervention is part of guidelines-based care, the implementation of these recommendation in actual US practice remains poorly described.

Objectives: This study aims to characterize patients presenting with OHCA and MI in a cohort from 4 hospitals, to assess care of these patients in actual practice.

Methods: We employed a database of OHCA patients admitted to four hospitals within the University of Pennsylvania Hospital System between 01/2019-12/2023. For this study, we included all patients that were diagnosed with STEMI during emergency department evaluation, and collected demographic, arrest, coronary angiographic, and ECG data from electronic health records. SAS was used for statistical analysis.

Results: A total of 43 MI cases were included; mean age was 60.6±11.8 y, 65% male, mean BMI 30.0±6.3, 58.1% African American, 27.9% White or Caucasian, and 16.3% had a medical history of myocardial infarction. 74.4% were witnessed, and 44.2% received bystander CPR[BA1] . Initial shockable rhythm was present in 34.9%. 38 survived to hospital admission, and 9 were discharged alive. The first obtained 12-lead ECG (median time to ECG: 13min, (IQR: 3.5-26.5)) found that ST-segment elevations were present in 88.4%, ST-segment depressions in 44.2%, T-wave inversions in 4.7%, QT prolongation in 9.3%, and wide QRS in 18.6%. Sinus rhythm was most common (41.9%), followed by junctional rhythm (9.3%). Left and right bundle branch blocks (4.3% and 7%, respectively) and AV block (7%) were recorded. Coronary angiography (median time to angiography: 1.95hr (IQR: 1.3-4.2)) was performed in 29 patients and revealed that left anterior descending artery (28.6%) was the most common location for a culprit lesion, followed by the right coronary artery (21.4%), and left circumflex artery (10.7%). Notably, in 21.4% of cases, no culprit lesion was identified. 13 patients underwent angioplasty with stent, 4 received balloon angioplasty, and 1 underwent aspiration thrombectomy.

Conclusion: This study highlights important attributes of OHCA patients presenting with MI. This paves the way for larger studies comparing ECG and coronary angiography findings between MI and control populations to help identify and improve acute care for OHCA MI patients.