Abstract P29: The Efficacy of Emergency Coronary Reperfusion Therapy for Comatose Survivors After Out-of-hospital Cardiac Arrest is Equivalent to Cardiogenic Shock Complicating ST-elevation Myocardial Infarction
BACKGROUNDS: AHA guidelines for ST-elevation myocardial infarction (STEMI) have recommended early coronary revascularization for patients with cardiogenic shock complicating STEMI (Circulation 2004;110:586 – 636). ILCOR has suggested that STEMI patients with post-cardiac arrest should undergo emergency coronary angiography, with subsequent reperfusion therapy (Circulation 2008; 118:2452–2483). We investigated whether early coronary reperfusion therapy had survival benefits for STEMI patients with post-cardiac arrest.
METHODS: We did a multicenter observation study of STEMI patients. Of those patients, comatose survivor or cardiogenic shock were enrolled in this study. The primary endpoint was survival to hospital discharge.
RESULTS: A total of 3,633 STEMI patients were admitted to the CCU in the Tokyo CCU network. Of those, 249 were enrolled in this study (88 in comatose survivors after out-of-hospital cardiac arrest and 161 in cardiogenic shock). Emergency coronary reperfusion therapy was performed 80 % in the cardiac arrest(CA) group, and 78% in the shock group (p=0.67). In the overall survival rate, no significant difference was seen between the CA-group and the Shock-group (66 % vs. 60%; p=0.32). However, the survival rates were significant higher in each group of patients treated with reperfusion therapy than no-reperfusion therapy (the CA-group: 77% vs. 25%, P<0.01, the Shock-group: 69% vs. 29%, P<0.01). And no significant difference was seen between the CA-group and the Shock-group in the survival rate of the patients who underwent reperfusion therapy (the CA-group: 77% vs. 69%, P=0.3).
CONCLUSIONS: Emergency coronary reperfusion therapy improved the survival in STEMI patients with not only cardiogenic shock but also out-of-hospital cardiac arrest, and the two groups had similar survival rate at about 70%.
This research has received full or partial funding support from the American Heart Association, National Center.