Out-of-hospital cardiac arrest and percutaneous coronary intervention for ST-elevation myocardial infarction: long-term survival and neurological outcome.
BACKGROUND
Predictors of long-term outcome after ST-elevation myocardial infarction (STEMI) complicated by out-of-hospital cardiac arrest (OHCA) are incompletely understood, including the influence of successful coronary reperfusion.


METHODS
We analysed clinical and procedural data as well as 1-year outcome of 72 consecutive patients who underwent primary coronary intervention (PCI) after witnessed OHCA and STEMI and compared the results with 695 patients with STEMI and PCI, but without OHCA. Neurological recovery after OHCA was assessed using the Cerebral Performance Category (CPC) scale.


RESULTS
PCI was successful in 83.3% after OHCA vs. 84.3% in the non-OHCA group (p=0.87). One-year mortality was 34.7% vs. 9.5% (p<0.001). 58.3% of the OHCA-patients showed complete neurological recovery (CPC 1) or moderate neurological disability (CPC 2). Another 6.9% showed severe cerebral disability (CPC 3) or permanent vegetative status (CPC 4). Delay from collapse until start of Advanced Cardiopulmonary Life Support (ACLS) was shorter for survivors with CPC status ≤2 (median 1 min, range 0-11 min) compared to non-survivors or survivors with CPC status >2 (median 8 min, range 0-13 min), p<0.0001. Age-adjusted multivariate analysis identified 'unsuccessful PCI', 'vasopressors on admission' and 'start of ACLS after >6 min' as independent predictors of negative long-term outcome (death or CPC >2).


CONCLUSIONS
Mortality is high in patients with STEMI complicated by OHCA - even though PCI was performed with the same success rate as in patients without OHCA. The majority of survivors had favourable neurological outcomes at 1 year, especially if advanced life support had been started within ≤6 min and PCI was successful.
Department of Cardiology, University Hospital Erlangen-Nuremberg, Germany. stefan.zimmermann@uk-erlangen.de
Stefan
S
Zimmermann
Frank A
FA
Flachskampf
Anna
A
Alff
Reinhard
R
Schneider
Katharina
K
Dechant
Lutz
L
Klinghammer
Christian
C
Stumpf
Yurdaguel
Y
Zopf
Thomas
T
Loehr
Georg
G
Brand
Josef
J
Ludwig
Werner G
WG
Daniel
Stephan
S
Achenbach
D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D009422:Nervous System Diseases / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome