title: Outcomes following primary percutaneous coronary intervention in the setting of cardiac arrest: a registry database study.
abstract: BACKGROUND
  The mortality rate among patients undergoing primary percutaneous coronary intervention (PPCI) in the setting of cardiac arrest (CA) and whether the location where the patient sustains CA influences the outcome is not known in the contemporary era.
  
  
  METHODS
  Prospectively collected data at a tertiary cardiac centre on all patients undergoing PPCI for ST elevation myocardial infarction (STEMI) in the setting of CA was analysed.
  
  
  RESULTS
  In total, 484/4118 (11.8%) patients sustained CA during the study period. Of these, 91/484 (18.8%) sustained CA prior to ambulance arrival, the remainder occurred either after ambulance arrival or in hospital. The overall in-hospital mortality was 20.5% in this cohort. Those sustaining CA before ambulance arrival experienced the highest unadjusted mortality compared to those that had CA after ambulance arrival, in hospital and in the catheterisation laboratory (29.7% versus 12.0%, 16.1% and 23.8% respectively, p=0.03). Multiple logistic regression analysis showed that the following parameters are independent predictors of in-hospital mortality: age (odds ratio (OR) for each year increment of age 1.05; 95% confidence interval (CI) 1.02-1.08, p=0.0009); female gender (OR 2.42; 95% CI 1.17-4.99, p=0.0173); previous PCI (OR 7.59; 95% CI 1.72-33.53, p=0.0075); asystole/ electromechanical dissociation (EMD) (OR 13.43; 95% CI 5.34-33.80, p<0.0001); and patient location at arrest (OR 5.77 for before ambulance arrival; 95% CI 2.55-13.07, p<0.0001).
  
  
  CONCLUSIONS
  In conclusion, in-hospital mortality remains high among patients undergoing PPCI in the context of CA, particularly among those that arrest prior to ambulance arrival.
authors.affiliation: Institute of Cellular Medicine, Newcastle University, UK Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK vijay.kunadian@newcastle.ac.uk.
authors.forename: Vijay
authors.initials: V
authors.lastname: Kunadian
authors.affiliation: Institute of Cellular Medicine, Newcastle University, UK Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK.
authors.forename: Bilal
authors.initials: B
authors.lastname: Bawamia
authors.affiliation: Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK.
authors.forename: Annette
authors.initials: A
authors.lastname: Maznyczka
authors.affiliation: Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK.
authors.forename: Azfar
authors.initials: A
authors.lastname: Zaman
authors.affiliation: Channing Division of Network Medicine, Brigham and Women's Hospital/Harvard Medical School, USA.
authors.forename: Weiliang
authors.initials: W
authors.lastname: Qiu
mesh_terms: D016887:Cardiopulmonary Resuscitation; D017023:Coronary Angiography / Q000401:mortality / Q000706:statistics & numerical data; D003325:Coronary Care Units / Q000706:statistics & numerical data; D005260:Female; D006323:Heart Arrest / Q000150:complications* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000401:mortality*; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome
keywords: Cardiac arrest; asystole; mortality; primary percutaneous coronary intervention