Survival and neurologic recovery in patients with ST-segment elevation myocardial infarction resuscitated from cardiac arrest.
OBJECTIVE
We examined outcomes of patients resuscitated from cardiac arrest owing to ST-segment elevation myocardial infarction (STEMI) and predictors of survival and neurologic recovery.


BACKGROUND
Immediately after resuscitation from cardiac arrest owing to STEMI, many patients show signs of neurologic impairment, and benefits of percutaneous coronary intervention and subsequent prognosis are not well defined.


METHODS
Between January 1, 2002, and December 31, 2006, we retrospectively identified consecutive patients resuscitated from cardiac arrest, regardless of time to return of spontaneous circulation (ROSC) and neurologic status, and reviewed the outcomes of those who had STEMI. Mortality and neurologic recovery at discharge and long-term mortality were assessed by individual chart review for those who underwent emergent angiography.


RESULTS
Our study population consisted of 98 patients; 64% survived to discharge, and 92% had a full neurologic recovery. Predictors of survival were shorter time to ROSC, younger age, neurologic status post-resuscitation (alert or minimally responsive), and male sex. Predictors of neurologic recovery included shorter time to ROSC, neurologic status post-resuscitation (alert or minimally responsive), and younger age. Ninety-six percent of patients who were alert post-resuscitation survived. Ninety-three percent of patients who were minimally responsive post-resuscitation survived. Fifty-nine patients were unresponsive post-resuscitation, with 44% survival, of whom 88% had full neurologic recovery. In the unresponsive group, unwitnessed arrest, prolonged ROSC, and older age were associated with increased risk of death, and older age and prolonged ROSC predicted poor neurologic recovery.


CONCLUSIONS
When resuscitated patients with STEMI are being evaluated in the emergency department, serious consideration should be given to emergent angiography and revascularization, regardless of neurologic status.
Hosmane
Vinay R
VR
Department of Medicine/Cardiology, Christiana Care Health System, Newark, Delware 19718, USA.
Mustafa
Nowwar G
NG
Reddy
Vivek K
VK
Reese
Charles L
CL
DiSabatino
Angela
A
Kolm
Paul
P
Hopkins
James T
JT
Weintraub
William S
WS
Rahman
Ehsanur
E
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D016887:Cardiopulmonary Resuscitation / Q000401:mortality*; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy; D009422:Nervous System Diseases / Q000209:etiology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome