Abstract 10577: The Effect of Emergency Percutaneous Coronary Intervention for Patients with Post Cardiac Arrest Syndrome in Tokyo CCU Network
BACKGROUND: Acute myocardial infarction (AMI) is the most common cause of sudden cardiac arrest. The 2010 AHA guidelines for cardiopulmonary resuscitation and emergency cardiovascular care recommended that not only patients with cardiogenic shock complicating AMI but also comatose survivors after out-of-hospital cardiac arrest due to presumed AMI should undergo emergency coronary angiography and subsequent coronary reperfusion therapy if needed. However, there are few comparative studies of percutaneous coronary intervention (PCI) of those two groups.
METHODS: We compared the effects of PCI between the AMI patients with post cardiac arrest syndrome and those with cardiogenic shock from the data of Tokyo CCU Network Registry, a prospective, multicenter observation registry of emergency cardiovascular care. The primary endpoint was survival to hospital discharge.
RESULTS: Of the 7,311 AMI patients who were admitted to CCU in the Tokyo CCU Network, 584 were enrolled in this study; 206 were post cardiac arrest patients (Arrest group), and 378 were cardiogenic shock patients (Shock group). The two groups had similar performance rate in the emergency coronary angiography (85% in the Arrest group vs. 85% in the Shock group, p=0.88). No significant differences were seen between the Arrest group and the Shock group in the whole cohort (69% vs. 62%, p=0.07), in the subgroups of patients who underwent emergency PCI (76% vs. 67%, p=0.07), and in the subgroups of patients who did not receive emergency PCI (47% vs. 46%, p=0.88). In addition, the survival rate was higher in the patients who succeeded coronary reperfusion than in those who failed coronary reperfusion in each group (The Arrest group; 86% vs.43%, p<0.001, The Shock group; 78% vs.38%, p<0.001, respectively).
CONCLUSION: Success of emergency coronary reperfusion therapy improved survival for AMI patients with not only cardiogenic shock but also post cardiac arrest. Successful coronary reperfusion for post cardiac arrest is equivalent to that for cardiogenic shock in terms of survival benefits.
- © 2011 by American Heart Association, Inc.