Abstract 190: The Efficacy of Emergency Coronary Revascularization Therapy for Patients With Post Cardiac Arrest Syndrome Complicating Acute Myocardial Infarction
Backgrounds: Acute myocardial infarction (AMI) is the most common cause of sudden cardiac arrest. ILCOR has suggested that AMI patients with post cardiac arrest should undergo emergency coronary angiography, with subsequent revascularization therapy (Circulation 2008; 118:2452–2483). AHA guidelines for AMI have recommended early coronary revascularization for patients with cardiogenic shock complicating AMI (Circulation 2004;110: 586–636). We investigated whether emergency coronary revascularization therapy had survival benefits for AMI patients with post-cardiac arrest.
Methods: We did a multicenter observation study of emergency cardiovascular care in the Tokyo CCU Network. Of the AMI patients who admitted the CCU, patients with post cardiac arrest syndrome or cardiogenic shock were enrolled in this study. The primary endpoint was survival to hospital discharge.
Results: Of the 5,337 AMI patients who admitted the CCU, 413 were enrolled in this study; 142 was post cardiac arrest (Arrest group), and 271 was cardiogenic shock (Shock group). Both groups had similar performances of emergency coronary angiography at about 80%, and of emergency coronary revascularization therapy under coronary angiography at about 90%. No significant differences were seen in the survival rate between the Arrest group and the Shock group in all study patients (68 % vs. 61%; p=0.17), and in the subgroup of patients who underwent emergency coronary angiography (77% % vs. 67%; p=0.06). However, the survival rate of the patients who underwent coronary revascularization therapy was higher in the Arrest group than in the Shock group (79% vs. 68%; p=0.048). Furthermore, in each group, the survival rate was higher in the patients who succeeded coronary revascularization than in those who failed coronary revascularization (Arrest group; 87% vs. 52%, p<0.001, Shock group; 77% vs.34%, p<0.001, respectively).
Conclusion: Emergency coronary revascularization therapy for post cardiac arrest patients complicating AMI had survival benefits. Success of emergency coronary revascularization therapy improved the survival for AMI patients with not only cardiogenic shock but also cardiac arrest.
- © 2010 by American Heart Association, Inc.