title: Primary percutaneous coronary intervention after out-of-hospital cardiac arrest: patients and outcomes.
abstract: BACKGROUND
  The decision to perform primary percutaneous coronary intervention in unconscious patients resuscitated after out-of-hospital cardiac arrest is challenging because of uncertainty regarding the prognosis of recovery of anoxic brain damage and difficulties in interpreting ST segment deviations. In ST elevation myocardial infarction patients after OHCA, primary PCI is generally considered the only option for reperfusion. There are few published studies and no randomized trial has yet been performed in this specific group of patients.
  
  
  OBJECTIVE
  To define the demographic, clinical and angiographic characteristics, and the prognosis of STEMI patients undergoing primary PCI after out-of-hospital cardiac arrest.
  
  
  METHODS
  We performed a retrospective analysis of medical records and used the prospectively acquired information from the Rambam Primary Angioplasty Registry (PARR) and the Rambam Intensive Cardiac Care (RICCa) databases.
  
  
  RESULTS
  During the period March 1998 to June 2006, 25 STEMI patients (21 men and 4 women, mean age 56 +/- 11years) after OHCA were treated with primary PCI. The location of myocardial infarction was anterior in 13 patients (52%) and non-anterior in 12 (48%). Cardiac arrest was witnessed in 23 patients (92%), but bystander resuscitation was performed in only 2 patients (8%). Eighteen patients (72%) were unconscious on admission, and Glasgow Coma Scale > 5 was noted in 2 patients (8%). Cardiogenic shock on admission was diagnosed in 4 patients (16%). PCI procedure was successful in 22 patients (88%). In-hospital, 30 day, 6 month and 1 year survival was 76%, 76%, 76% and 72%, respectively. In-hospital, 30 day, 6 month and 1 year survival without severe neurological disability was 68%, 68%, 68% and 64%, respectively.
  
  
  CONCLUSIONS
  In a selected group of STEMI patients after out-of-hospital cardiac arrest, primary PCI can be performed with a high success rate and provides reasonably good results in terms of short and longer term survival.
authors.affiliation: Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
authors.forename: Erez
authors.initials: E
authors.lastname: Marcusohn
authors.forename: Erez
authors.initials: E
authors.lastname: Markusohn
authors.forename: Ariel
authors.initials: A
authors.lastname: Roguin
authors.forename: Anat
authors.initials: A
authors.lastname: Sebbag
authors.forename: Doron
authors.initials: D
authors.lastname: Aronson
authors.forename: Robert
authors.initials: R
authors.lastname: Dragu
authors.forename: Shlomo
authors.initials: S
authors.lastname: Amikam
authors.forename: Monter
authors.initials: M
authors.lastname: Boulus
authors.forename: Ehud
authors.initials: E
authors.lastname: Grenadier
authors.forename: Arthur
authors.initials: A
authors.lastname: Kerner
authors.forename: Eugenia
authors.initials: E
authors.lastname: Nikolsky
authors.forename: Walter
authors.initials: W
authors.lastname: Markiewicz
authors.forename: Haim
authors.initials: H
authors.lastname: Hammerman
authors.forename: Michael
authors.initials: M
authors.lastname: Kapeliovich
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D017023:Coronary Angiography; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D010045:Outpatients; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome