Emergency percutaneous coronary intervention in patients with ST-elevation myocardial infarction complicated by out-of-hospital cardiac arrest: early and medium-term outcome.
BACKGROUND
The role of emergency reperfusion therapy in patients with ST-elevation myocardial infarction (STEMI) resuscitated after an out-of-hospital cardiac arrest (OHCA) has not been clearly established yet. The aim of this study was to evaluate the in-hospital and postdischarge outcomes of STEMI patients surviving OHCA and undergoing emergency angioplasty (percutaneous coronary intervention [PCI]) within an established regional network.


METHODS
We prospectively collected data on 2,617 consecutive patients with STEMI treated with emergency PCI in 2005; in-hospital and 6-month outcomes of 99 patients who had experienced OHCA were compared with those of 2,518 patients without OHCA. The OHCA patients also underwent a cerebral performance evaluation after 12 months.


RESULTS
OHCA patients were at higher clinical risk at presentation (cardiogenic shock 26% vs 5%, P < .0001). Percutaneous coronary intervention was successful in 80% of the OHCA and 89% of the non-OHCA patients (P = NS). In-hospital mortality rates were 22% and 3%, respectively (P < .0001). Independent predictors of in-hospital mortality among OHCA patients were longer delay between the call to the emergency medical system and the start of cardiopulmonary resuscitation (odds ratio [OR] 3.5, P = .03), nonshockable initial rhythms (OR 10.5, P = .002), cardiogenic shock (OR 3.05, P = .035), and a Glasgow Coma Scale score of 3 on admission (OR 2.9, P = .032). The 6-month composite rate of death, myocardial infarction, and revascularization among OHCA patients surviving the acute phase was comparable to that of non-OHCA patients (16% vs 13.9%, P = NS), and 87% of them showed a favorable neurologic recovery after 1 year.


CONCLUSIONS
Resuscitated OHCA patients undergoing emergency PCI for STEMI have worse clinical presentation and higher in-hospital mortality compared to those without OHCA. However, subsequent cardiac events are similar, and neurologic recovery is more favorable than reported in most previous series.
Lettieri
Corrado
C
Department of Cardiology, Ospedale Carlo Poma, Mantova, Italy. corrado.lettieri@ospedalimantova.it
Savonitto
Stefano
S
De Servi
Stefano
S
Guagliumi
Giulio
G
Belli
Guido
G
Repetto
Alessandra
A
Piccaluga
Emanuela
E
Politi
Alessandro
A
Ettori
Federica
F
Castiglioni
Battistina
B
Fabbiocchi
Franco
F
De Cesare
Nicoletta
N
Sangiorgi
Giuseppe
G
Musumeci
Giuseppe
G
Onofri
Marco
M
D'Urbano
Maurizio
M
Pirelli
Salvatore
S
Zanini
Roberto
R
Klugmann
Silvio
S
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000150:complications* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000628:therapy*; D011379:Prognosis; D012151:Resuscitation; D012770:Shock, Cardiogenic / Q000628:therapy; D015607:Stents; D016896:Treatment Outcome