title: Six-month outcome of emergency percutaneous coronary intervention in resuscitated patients after cardiac arrest complicating ST-elevation myocardial infarction.
abstract: BACKGROUND
  The outcome of resuscitated patients after cardiac arrest complicating acute myocardial infarction remains poor, primarily because of the relatively low success rates of cardiopulmonary resuscitation management. Existing data suggest potential beneficial effects of early myocardial reperfusion, but the predictors of survival in these patients remain unknown.
  
  
  RESULTS
  From 1995 to 2005, 186 patients (78% men; mean age, 60.4+/-13.8 years) underwent immediate percutaneous coronary intervention after successful resuscitation for cardiac arrest complicating acute myocardial infarction. Prompt prehospital management was performed by mobile medical care units in 154 of 186 patients, whereas 32 had in-hospital cardiac arrest. Infarct location was anterior in 105 patients (56%), and shock was present on admission in 96 (52%). Percutaneous coronary intervention (stenting rate 90%) was successful in 161 of 186 patients (87%). Six-month survival rate was 100 of 186 (54%), and 6-month survival free of neurological sequelae was 46%. By multivariate analysis, predictors of 6-month survival were a shorter interval between the onset of cardiac arrest and arrival of a first responder (odds ratio, 0.67; 95% CI, 0.54 to 0.84), a shorter interval between the onset of cardiac arrest and return of spontaneous circulation (odds ratio, 0.91; 95% CI, 0.87 to 0.96), and absence of diabetes (odds ratio, 7.30; 95% CI, 1.80 to 29.41).
  
  
  CONCLUSIONS
  In patients with resuscitated cardiac arrest complicating acute myocardial infarction, prompt prehospital management and early revascularization were associated with a 54% survival rate at 6 months. A strategy including adequate prehospital management, early revascularization, and specific care in dedicated intensive care units should be strongly considered in resuscitated patients after cardiac arrest complicating acute myocardial infarction.
authors.affiliation: Institut Cardiovasculaire Paris-Sud, Centre Hospitalier Claude Galien, 20 Route de Boussy, 91480 Quincy, France. p.garot@icps.com.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Garot
authors.forename: Thierry
authors.initials: T
authors.lastname: Lefevre
authors.forename: Hélène
authors.initials: H
authors.lastname: Eltchaninoff
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Morice
authors.forename: Fabienne
authors.initials: F
authors.lastname: Tamion
authors.forename: Bernard
authors.initials: B
authors.lastname: Abry
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: Lesault
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Le Tarnec
authors.forename: Claude
authors.initials: C
authors.lastname: Pouges
authors.forename: Alain
authors.initials: A
authors.lastname: Margenet
authors.forename: Mehran
authors.initials: M
authors.lastname: Monchi
authors.forename: Ivan
authors.initials: I
authors.lastname: Laurent
authors.forename: Pierre
authors.initials: P
authors.lastname: Dumas
authors.forename: Jérôme
authors.initials: J
authors.lastname: Garot
authors.forename: Yves
authors.initials: Y
authors.lastname: Louvard
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality* / Q000706:statistics & numerical data; D006328:Cardiac Catheterization / Q000401:mortality / Q000706:statistics & numerical data; D016887:Cardiopulmonary Resuscitation / Q000401:mortality* / Q000706:statistics & numerical data; D003422:Critical Care / Q000706:statistics & numerical data; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome