Feasibility and safety of combined percutaneous coronary intervention and therapeutic hypothermia following cardiac arrest.
METHODS
Mild therapeautic hypothermia (MTH) has been associated with cardiac dysrhythmias, coagulopathy and infection. After restoration of spontaneous circulation (ROSC), many cardiac arrest patients undergo percutaneous coronary intervention (PCI). The safety and feasibility of combined MTH and PCI remains unclear. This is the first study to evaluate whether PCI increases cardiac risk or compromises functional outcomes in comatose cardiac arrest patients who undergo MTH.


METHODS
Ninety patients within a 6-h window following cardiac arrest and ROSC were included. Twenty subjects (23%) who underwent PCI following MTH induction were compared to 70 control patients who underwent MTH without PCI. The primary endpoint was the rate of dysrhythmias; secondary endpoints were time-to-MTH induction, rates of adverse events (dysrhythmia, coagulopathy, hypotension and infection) and mortality.


RESULTS
Patients who underwent PCI plus MTH suffered no statistical increase in adverse events (P=.054). No significant difference was found in the rates of dysrhythmias (P=.27), infection (P=.90), coagulopathy (P=.90) or hypotension (P=.08). The PCI plus MTH group achieved similar neurological outcomes (modified Rankin Scale (mRS) <or=3 (P=.42) and survival rates (P=.40). PCI did not affect the speed of MTH induction; the target temperature was reached in both groups without a significant time difference (P=.29).


CONCLUSIONS
Percutaneous coronary intervention seems to be feasible when combined with MTH, and is not associated with increased cardiac or neurological risk.
Batista
Leonardo M
LM
Department of Neurology, J Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114-3117, USA.
Lima
Fabricio O
FO
Januzzi
James L
JL
Donahue
Vivian
V
Snydeman
Colleen
C
Greer
David M
DM
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D001145:Arrhythmias, Cardiac / Q000209:etiology; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy; D012151:Resuscitation / Q000379:methods; D012189:Retrospective Studies