Abstract 165: Percutaneous Left Ventricular Support Improves Survival in Patients Undergoing Emergency Percutaneous Coronary Intervention After Cardiac Arrest Complicating STEMI
Introduction: Patients with acute ST segment elevation myocardial infarction (STEMI) and cardiac arrest have a very poor prognosis, primarily due to low success rates of cardiopulmonary resuscitation and post-resuscitation care. Recent data suggest that early myocardial reperfusion via primary percutaneous coronary intervention (PCI) may improve survival by preserving ischemic myocardium. However, mortality rates secondary to post-resuscitation myocardial dysfunction remain high and the role of percutaneous ventricular assist devices in improving outcomes is unknown.
Methods: A retrospective review was performed a tertiary care university hospital of all patients presenting with cardiac arrest complicating STEMI who underwent primary PCI from 2004 to 2010. The primary endpoint was 30 day survival. Multiple stepwise logistic regression was used to identify independent predictors of 30 day survival.
Results: 87 patients (80% male, mean age 61.3+/-14.3 years) were identified and there were no significant differences in baseline characteristics. 55 (63.2%) were in cardiogenic shock (SBP < 90mmHg on at least 2 vasopressors) upon arrival to the cardiac catheterization laboratory and 81 (93.1%) had a successful intervention. Overall 30 day survival was 39.1% (34/87). An IABP was placed in 37 (42.5%) and 16 (18.4%) received either an Impella (2.5 or 5.0) left ventricular assist device or a TandemHeart device. By multivariate analysis, predictors of 30 day survival were treatment with percutaneous left ventricular assist devices (odds ratio 0.57, 95% CI 0.39-0.78), shorter duration of CPR until return of spontaneous circulation (odds ratio 0.72, 95% CI 0.45-0.91), and age < 70 years (OR 0.77, 95% CI 0.51-0.95).
Conclusions: In patients who underwent emergent percutaneous coronary intervention for STEMI complicated by cardiac arrest, percutaneous ventricular support is associated with improved 30 day survival. Ventricular support during the intervention and after the cardiac arrest may amerliorate the deleterious effects of post-resuscitation myocardial dysfunction and may have a role in the management of resuscitated patients with STEMI.
- © 2011 by American Heart Association, Inc.