Abstract 19239: Survival and Neurologic Recovery in Patients With ST-Elevation After Resuscitation from Cardiac Arrest Found to Have Non-Obstructive Disease on Angiography
Methods: We examined records of 3502 consecutive patients at our institution suspected of having ST-Elevation myocardial infarction (STEMI) from 1/1/02 to 12/31/08. One hundred thirty-five patients were found to have EKG evidence of STEMI after being resuscitated from cardiac arrest. Of these, 129 were taken for emergent catheterization. Sixteen patients had non-obstructive coronary disease (CAD) on catheterization with no obvious culprit lesion, while 113 had obstructive CAD. Endpoints were survival to hospital discharge and neurologic recovery among the two groups.
Results: Overall, 83 patients survived (64.3%) with 75 of the 129 (58.1%) having full neurologic recovery. After resuscitation, 37 were alert, 14 minimally responsive, and 78 were unresponsive. Of the 113 patients with obstructive CAD, 96 were revascularized (PCI/Surgery). There was no statistically significant difference in survival (43.8% vs 67.3%, p=0.067) or full neurologic recovery (37.5% vs 61.1%, p=0.081) between patients with non-obstructive vs obstructive CAD. In patients that were initially unresponsive after resuscitation, overall survival was 43.6%. There was a trend towards survival for non-obstructive compared to obstructive CAD in these unresponsive patients, but not significantly different. (18.2% vs 47.8%, p=0.067). Unresponsive patients with non-obstructive CAD had a lower incidence of full neurologic recovery (9.1% vs 39.7%, p=0.0455). (Table 1)
Conclusions: There was no significant difference in survival or neurologic recovery between patients with ST-elevation on post-resuscitation EKG based on whether they had obstructive or non-obstructive CAD. STEMI patients who are initially unresponsive after resuscitation are less likely to make full neurological recovery if they have non-obstructive versus obstructive coronary disease.
- Cardiac arrest
- Emergency care
- Myocardial infarction, STEMI
- Heart catheterization
- Myocardial revascularization
- © 2010 by American Heart Association, Inc.