title: Survival in patients with myocardial infarction complicated by out-of-hospital cardiac arrest undergoing emergency percutaneous coronary intervention.
abstract: OBJECTIVE
  We sought to evaluate the clinical outcomes of patients with myocardial infarction (MI) complicated by out-of-hospital cardiac arrest (OHCA) undergoing percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  Controversy remains regarding the benefit of early PCI in patients with MI complicated by OHCA.
  
  
  METHODS
  We analyzed the outcomes of 88 consecutive patients presenting with MI complicated by OHCA compared to 5101 patients with MI without OHCA who underwent PCI from the Melbourne Interventional Group registry between 2004 and 2009.
  
  
  RESULTS
  Patients with OHCA had a higher proportion of ST-elevation MI presentations (90.9% vs. 50%, p<0.01) and were more likely to be to be in cardiogenic shock (38.6% vs. 4.6%, p<0.01). Procedural success was similar in the two groups (95.5% OHCA vs. 96.5% non-OHCA MI cohort, p=0.65). In-hospital, 30-day, and 1-year survival in the OHCA cohort versus the non-OHCA MI cohort were 62.5% vs. 97.2% (p<0.01), 61.4% vs. 96.5% (p<0.01), and 60.2% vs. 94.2% (p<0.01), respectively. Within the OHCA cohort, presentation with cardiogenic shock (OR 7.2, 95% CI: 2.7-18.8; p<0.01) was strongly associated with in-hospital mortality. Importantly, 1-year survival of patients discharged alive from hospital was similar between the two groups (96% vs. 97% p=0.8).
  
  
  CONCLUSIONS
  Patients with MI complicated by OHCA remain a high-risk group associated with high mortality. However, high procedural success rates similar to non-OHCA patients can be attained. Survival rates better than previously reported were observed with an emergent PCI approach, with 1-year survival comparable to a non-OHCA cohort if patients survive to hospital discharge.
authors: Department of Cardiology, Austin Health, Melbourne, Australia.
authors: Han S
authors: HS
authors: Lim
authors: Dion
authors: D
authors: Stub
authors: Andrew E
authors: AE
authors: Ajani
authors: Nick
authors: N
authors: Andrianopoulos
authors: Christopher M
authors: CM
authors: Reid
authors: Kerrie
authors: K
authors: Charter
authors: Alexander
authors: A
authors: Black
authors: Karen
authors: K
authors: Smith
authors: Gishel
authors: G
authors: New
authors: William
authors: W
authors: Chan
authors: Chris C S
authors: CC
authors: Lim
authors: Omar
authors: O
authors: Farouque
authors: James
authors: J
authors: Shaw
authors: Angela
authors: A
authors: Brennan
authors: Stephen J
authors: SJ
authors: Duffy
authors: David J
authors: DJ
authors: Clark
mesh_terms: D000368:Aged; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000401:mortality*; D012042:Registries; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome