Abstract 11396: Therapeutic Hypothermia in Patients with ST-Segment Elevation Myocardial Infarction Surviving Out-of-Hospital Cardiac Arrest in the Context of a Reginal Primary PCI Program
Background: Therapeutic hypothermia (TH) improves outcomes in comatose patients (pts) after out-of-hospital cardiac arrest. However, there is limited data concerning TH applied after cardiac arrest in comatose pts with ST-segment elevation myocardial infarction (STEMI). We sought to determine the outcome of pts presenting with a cardiac arrest associated with STEMI who were referred for primary PCI and treated with TH.
Methods: By using the University of Heart Institute STEMI database, we identified pts referred for primary PCI who required TH following out-of-hospital cardiac arrest. The primary outcome was survival measured at 180 days. Secondary outcomes included length of hospital stay and destination upon discharge.
Results: A total of 1570 consecutive pts with confirmed STEMI were referred for primary PCI between July 2004 and May 2009. Amongst these pts, we identified 26 who required TH following out-of-hospital cardiac arrest. The demographics of these pts are shown in Table 1. All 26 pts had primary PCI: 24 underwent stent implantation; 1 balloon angioplasty alone; and 1 thrombectomy alone. All 26 pts were successfully cooled to a temperature goal of 32–33C. Eighteen pts (69%) were discharged alive. Of these, 16 were discharged home, 1 pt to a long-term care facility and 1 pt for physical rehabilitation. The length of hospital stay for survivors was 19 days (IQR = 12–27). All 18 pts surviving to discharge were alive at 180-day follow-up.
Conclusion: A strategy of TH coupled with primary PCI in comatose pts resuscitated from out-of-hospital cardiac arrest was associated with a relatively good survival. Using hospital discharge to home as a marker of functional recovery also suggests that this approach may be associated with improved neurological outcomes in this high risk cohort.
- © 2010 by American Heart Association, Inc.