Abstract 3168: Five-year Follow-Up of Survivors of Cardiac Arrest Occurring in the Course of ST-Elevation Myocardial Infarction Prior to Primary Percutaneous Coronary Angioplasty - Anin Myocardial Infarction Registry
Impact of cardiac arrest preceding primary PCI (pPCI) in STEMI patients (pts) on long-term prognosis has not been established yet. Aim of this study was to demonstrate 5-year clinical outcome of such pts in relation to extent of resuscitation procedures.
Material and Methods: Interrogation of a prospective Myocardial Infarction Registry, where every PCI procedure for ACS performed on an emergent basis in our tertiary very-high volume centre is included. Data in the Registry are collected prospectively on pre-printed forms. More than 90% of registry has been re-validated against patient records. Follow-up data were obtained by phone-calls to pts, from outpatients’ records and from National Population Registry.
Results: Out of 1064 STEMI pts treated with pPCI in years 2001–2002 78 pts (8%) had suffered cardiac arrest (CA) before pPCI was performed: 37 pts required DC shock only (median age 57 years, 87% male, 6% post MI, 5% diabetic), whereas 41 pts had full resuscitation (median age 59 years, 78% male, 25% post MI, 22% diabetic). Follow-up as of April 2007 was 100% complete; 22 pts have died. As a whole, pts who had suffered CA had limited survival (30-day, 1-year, and 5-year mortality was 18%, 22%, and 26%, respectively). However, DC shock pts differed markedly from chest compression pts and had significantly lower 30-day (0% vs. 34%), 1-year (3% vs. 39%) and 5-year (9% vs. 42%) mortality. Moreover, DC shock patients tended to have better outcome than pts with no CA prior to pPCI (30-day mortality 0% vs. 4%, 1-year mortality 3% vs. 7%). We hypothesized that since VF may be a sign of spontaneous reperfusion, the above finding could result from higher rate of pre-pPCI reperfusion in the DC shock group as compared to no CA group. However, on the contrary, the rate of pre-pPCI TIMI 3 flow tended to be lower in the DC shock group than in no CA group 5% vs. 9%).
Conclusions: Long-term outcome of pts with STEMI treated with pPCI preceded by cardiac arrest depends on whether pts had to be fully resuscitated or required defibrillation only. Prognosis of patients who were defibrillated only is not inferior to pts without pre-pPCI cardiac arrest. It seems that indication for pPCI needs to be individually established in pts who had been fully resuscitated, especially if they remain unconscious.