This Article Full Text Full Text (PDF) All Versions of this Article: 115/11/1354    most recent CIRCULATIONAHA.106.657619v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Garot, P. Articles by Louvard, Y. Search for Related Content PubMed PubMed Citation Articles by Garot, P. Articles by Louvard, Y. Pubmed/NCBI databases Medline Plus Health Information Angioplasty CPR Emergency Medical Services Heart Attack Related Collections Health policy and outcome research Acute myocardial infarction CPR and emergency cardiac care Related Article

(Circulation. 2007;115:1354-1362.)
© 2007 American Heart Association, Inc.

Health Services and Outcomes Research

Six-Month Outcome of Emergency Percutaneous Coronary Intervention in Resuscitated Patients After Cardiac Arrest Complicating ST-Elevation Myocardial Infarction

Philippe Garot, MD; Thierry Lefevre, MD; Hélène Eltchaninoff, MD, PhD; Marie-Claude Morice, MD; Fabienne Tamion, MD; Bernard Abry, MD; Pierre-François Lesault, MD; Jean-Yves Le Tarnec, MD; Claude Pouges, MD; Alain Margenet, MD; Mehran Monchi, MD; Ivan Laurent, MD; Pierre Dumas, MD; Jérôme Garot, MD, PhD; Yves Louvard, MD

From Institut Cardiovasculaire Paris-Sud, Massy and Quincy (P.G., T.L., M.-C.M., B.A., M.M., I.L., P.D., Y.L.); Cardiologie, Centre Hospitalier Charles Nicolle, Rouen (H.E., F.T., P.-F.L.); Service Aide Médicale d’Urgence Seine-et-Marne, Melun (J.-Y.L.T.); Service Aide Médicale d’Urgence Essonne, Corbeil-Essonnes (C.P.); Service Aide Médicale d’Urgence Val-de-Marne, Créteil (A.M.); and Cardiologie, Centre Hospitalier Henri Mondor, Créteil (J.G.), France.

Correspondence to Philippe Garot, MD, Institut Cardiovasculaire Paris-Sud, Centre Hospitalier Claude Galien, 20 Route de Boussy, 91480 Quincy, France. E-mail p.garot{at}icps.com.fr

Received August 13, 2006; accepted January 5, 2007.

Background— The outcome of resuscitated patients after cardiac arrest complicating acute myocardial infarction remains poor, primarily because of the relatively low success rates of cardiopulmonary resuscitation management. Existing data suggest potential beneficial effects of early myocardial reperfusion, but the predictors of survival in these patients remain unknown.

Methods and Results— From 1995 to 2005, 186 patients (78% men; mean age, 60.4±13.8 years) underwent immediate percutaneous coronary intervention after successful resuscitation for cardiac arrest complicating acute myocardial infarction. Prompt prehospital management was performed by mobile medical care units in 154 of 186 patients, whereas 32 had in-hospital cardiac arrest. Infarct location was anterior in 105 patients (56%), and shock was present on admission in 96 (52%). Percutaneous coronary intervention (stenting rate 90%) was successful in 161 of 186 patients (87%). Six-month survival rate was 100 of 186 (54%), and 6-month survival free of neurological sequelae was 46%. By multivariate analysis, predictors of 6-month survival were a shorter interval between the onset of cardiac arrest and arrival of a first responder (odds ratio, 0.67; 95% CI, 0.54 to 0.84), a shorter interval between the onset of cardiac arrest and return of spontaneous circulation (odds ratio, 0.91; 95% CI, 0.87 to 0.96), and absence of diabetes (odds ratio, 7.30; 95% CI, 1.80 to 29.41).

Conclusions— In patients with resuscitated cardiac arrest complicating acute myocardial infarction, prompt prehospital management and early revascularization were associated with a 54% survival rate at 6 months. A strategy including adequate prehospital management, early revascularization, and specific care in dedicated intensive care units should be strongly considered in resuscitated patients after cardiac arrest complicating acute myocardial infarction.

Key Words: angioplasty • cardiopulmonary resuscitation • heart arrest • myocardial infarction • shock

Related Article:

Issue Highlights
Circulation 2007 115: 1333. [Full Text]