title: Association between delay to coronary reperfusion and outcome in patients with acute coronary syndrome undergoing extracorporeal cardiopulmonary resuscitation.
abstract: The prognostic effect of early coronary reperfusion therapy with extracorporeal cardiopulmonary resuscitation (ECPR) in patients with cardiac arrest due to acute coronary syndrome (ACS) has yet to be clarified. We investigated the relationship between time interval from collapse to start of ECPR (CtoE) and coronary reperfusion (CtoR) time and neurological outcome in patients with cardiac arrest due to ACS.
  
  
  
  A cohort of 119 consecutive patients (63±12 years old) with ACS who underwent ECPR and percutaneous coronary intervention(PCI) at our hospital was registered from January 2005 to June 2016. We analyzed patient clinical outcome, which was defined as survival with good neurological outcome at 30 days. We divided the patients into four groups according to CtoR time: Group 1 (time<60min: n=19), Group 2 (60≤time<90min: n=19), Group 3 (time≥90min: n=70) and Group 4 (unsuccessful coronary reperfusion: n=11).
  
  
  
  One hundred patients (84%) were successful of PCI. A Kaplan-Meier curve showed that Group 1 had the best outcome among the four groups (good neurological outcome at 30 days; 74% vs 37% vs 23% vs 9%, P<0.0001). In receiver operating characteristics analysis for good neurological outcome at 30 days, the cutoff values for CtoE was 40min. The delay CtoE and CtoR time were independent predictors of poor neurological outcome at 30 days after adjusting multiple confounders (CtoE time; Hazard ratio (HR):1.026, 95% confidential intervals(CI): 1.011-1.042, P=0.001), (CtoR time; HR: 1.004, 95% CI: 1.001-1.008, P=0.020).
  
  
  
  A shorter CtoE and CtoR predicts better clinical outcome in patients with ACS undergoing ECPR.
authors.affiliation: Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kuroki
authors.affiliation: Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan. Electronic address: daisuke-a@mtg.biglobe.ne.jp.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Abe
authors.affiliation: Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Iwama
authors.affiliation: Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
authors.forename: Kou
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Emergency and Intensive Care Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Sugiyama
authors.affiliation: Emergency and Intensive Care Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Akashi
authors.affiliation: Emergency and Intensive Care Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Hamabe
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Aonuma
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Sato
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000628:therapy*; D000368:Aged; D000704:Analysis of Variance; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion / Q000379:methods*; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000150:complications / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Acute coronary syndrome; Cardiopulmonary bypass; Extracorporeal cardiopulmonary resuscitation; Extracorporeal membrane oxygenation; Percutaneous coronary intervention