Abstract 2227: Results of Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction Patients Following Cardiac Arrest
Background: Patients with cardiac arrest associated with STEMI are routinely excluded from clinical trials and therefore, almost no data exist regarding their outcomes with primary PCI. Patients with out of hospital cardiac arrest (OOHCA) are a particularly high-risk cohort and the appropriate reperfusion strategy for these patients is controversial.
Methods/Results: We determined the outcomes of patients who sustained a cardiac arrest prior to primary PCI in 1,500 consecutive patients with STEMI admitted to or transferred to a regional PCI center. Overall 159(10.6%) STEMI patients sustained a cardiac arrest prior to PCI, including 47 (3.1%) with OOHCA. The in-hospital, 30-day and 1-year mortality for patients without cardiac arrest, cardiac arrest excluding OOHCA and patients with OOHCA are included in table⇓. 53.3% of the deaths in OOHCA were related to anoxic brain injury compared to 9.1% of the deaths in patients with in-hospital cardiac arrest (p<0.003). Thirty-six percent of patients with OOHCA underwent a cooling protocol (return of spontaneous circulation and persistent neurologic impairment) with a 41% in-hospital mortality.
Conclusions: Cardiac arrest prior to PCI (including both OOHCA and in-hospital) in patients with STEMI is a major predictor for in-hospital mortality. Patients with cardiac arrest who survive to discharge subsequently do well. OOHCA has a higher mortality than in-hospital cardiac arrest and the majority of deaths are due to anoxic brain injury. Still, nearly 70% of OOHCA survived to discharge without neurological impairment.