Abstract 110: Prognosis of Patients Receiving Primary Percutaneous Coronary Intervention who Remain Comatose after Resuscitation from Cardiac Arrest in the Setting of ST Elevation Myocardial Infarction
Methods: We retrospectively examined the records of 552 consecutive ST elevation myocardial infarction patients from 1/1/02 to 6/30/03 at our institution. Emergent percutaneous coronary intervention (PCI) was performed in 389. Twenty-nine of them were resuscitated from cardiac arrest and remained comatose and intubated before PCI. Normal flow was restored in all 29 culprit vessels. The 29 patients were followed until death or discharge.
Results: There were 13 survivors (45%) out of 29 patients. Immediate CPR and time to return of spontaneous circulation (ROSC) were each prognostic indicators of survival. With immediate CPR, the odds of survival were 2.28 times greater than when immediate CPR was not instituted (p=0.0149). The odds of survival increased 1.11 times for every 1-minute decrease in time to ROSC (p=0.0297). Absence of a history of CHF was a predictor of survival (p = 0.0085). Fifty-five percent of those without a history of CHF survived, while only 17% with a history of CHF survived. Odds ratios were age adjusted. Eleven of 29 (38%) were discharged with full neurologic recovery and 2 were discharged with residual neurologic deficits.
Conclusion: If immediate CPR is applied, if ROSC time is short, and if there is no history of CHF, serious consideration should be given to emergent PCI after resuscitation (even if patient is comatose).