Abstract 243: Longterm Outcome After Out-of-Hospital Cardiac Arrest and Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction
Background: There is variability in the reported outcome of patients with out-of-hospital cardiac arrest (OHCA). Little is known about the role of coronary reperfusion strategies in patients with ST-elevation myocardial infarction (STEMI) complicated by OHCA
Methods: 30-day and 1-year outcome of 71 consecutive patients treated with primary percutaneous coronary intervention (PCI) after witnessed OHCA and STEMI were compared with the results of 695 STEMI patients without cardiac arrest who also underwent PCI. Neurological recovery of OHCA-patients was assessed using Cerebral Performance Category (CPC) scale at 1-year follow up.
Results: In 19.7% (14/71) of the OHCA patients initial rhythm was asystole, 83.1% (59/71) presented with mechanical ventilation and 46.5% (33/71) with vasopressors on admission. In 57.8% (41/71) of the OHCA-patients and 43.9% of the no-OHCA patients LAD was the infarction-related coronary vessel (p=0.03). 85.9% (61/71) versus 89.4% received a Stent (p=0.42) and PCI was successful in 83.1% (59/71) versus 84.2%, p=0.86. 30-day mortality was 26.8% (19/71) after OHCA versus 5.8% in the no-OHCA group, p=0.0001. EMS (Emergency Medical Service) arrival time was significantly shorter for 30-day survivors of OHCA (median 1min, range 1–11min) compared to non-survivors of OHCA (median 6min, range 1–10min), p<0.001. After 1 year mortality was 35.2% (25/71) in the OHCA-group versus 9.8% in the reference group, p<0.0001. Nevertheless 57.7% (41/71) of the OHCA-patients showed complete neurological recovery (CPC1) or moderate neurological disability (CPC2). Another 7% (5/71) showed severe cerebral disability (CPC3) or permanent vegetative status (CPC4).
Conclusions: As expected, mortality rates were high in patients with ST-elevation myocardial infarction (STEMI) complicated by OHCA — even if PCI was performed with the same success rate as in patients without OHCA. But more than half of these patients had a favourable neurological outcome at 1 year.
- © 2010 by American Heart Association, Inc.