Abstract 13080: Survival and Neurological Outcome aafter Out-of-Hosptal Cardiac Arrest Due to ST-Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

Abstract

Background: Out-of-hospital cardiac arrests (OHCA) are devastating events frequently caused by STEMI. Limited data exist covering prognosis after primary percutaneous coronary intervention (PCI) for OHCA due to STEMI.

Objectives: To identify prognostic factors of short term neurological and 1 year survival outcomes in OHCA patients treated with primary PCI.

Methods: A multicenter registry of patients treated with primary PCI for STEMI in 3 tertiary hospitals. Patients without return-of-spontaneous-circulation were excluded. Cerebral performance scale (CPC) was used as neurological endpoint and was scored retrospectively using chart review. Vital status was obtained through municipality records. Logistic and cox regression were used to identify predictors of poor CPC score and mortality, respectively.

Results: In total, 224 patients presented with OHCA vs. 3259 without arrest (WOA). OHCA patients were more often in cardiogenic shock (31% vs. 5% in WOA, p<0.001) and showed more left anterior descending (56% vs. 39% in WOA, p<0.001) culprits. TIMI flow after PCI was comparable. OHCA occurred prior to emergency medical system (EMS) arrival in 68% and unwitnessed in 6% of cases. Basic life support (BLS) was delayed for at least 5 minutes in 17% of patients and automatic external defibrillator (AED) use was 18%. In-hospital neurological outcome was poor (CPC >2 or dead) in 23% of OHCA patients. Mortality was higher at 30 days (17% in OHCA vs. 4% in WOA, p<0.001) and 1 year (19% in OHCA vs. 7% in WOA, p<0.001). Delay in BLS and OHCA before EMS arrival were strong predictors of adverse neurological and mortality outcome, while AED use predicted favorable CPC score (figure 1).

Conclusions: Mortality is high in patients after OHCA due to STEMI compared to non-arrest patients. Strong prognostic factors were identified, stressing the need for civilian BLS, use of AEDs and fast EMS response to improve neurological and survival outcome.