Abstract 17013: Higher Mortality for STEMI Complicated by Out of Hospital Arrest: Observations from The Los Angeles County STEMI Receiving Centers
Background: Primary percutaneous coronary intervention (PCI) performed for ST segment elevation myocardial infarction (STEMI) reduces mortality. The benefits and time intervals of primary PCI for STEMI complicated by out of hospital cardiac arrest (OHA) remain unclear.
Methods: The Los Angeles County STEMI Receiving Centers (SRC) coordinates 33 hospitals within Los Angeles County that provide emergency medical services (EMS) for the 9.8 million residents of Los Angeles County. Patients with OHA with ROSC and/or a pre-hospital (PH) ECG showing STEMI are transported to dedicated SRC hospitals for primary PCI and therapeutic hypothermia (TH). From April to December, 2011 663 patients with OHA and ROSC were transported by EMS. Sixty-one patients (9.2%) had a PH ECG showing STEMI and underwent primary PCI. During the same time period, 932 patients with no OHA and a PH ECG showing STEMI underwent primary PCI. Demographics, procedural success, treatment intervals and clinical outcome were compared between both groups.
Results: Thirty-six patients (59%) with OHA and STEMI received TH. Treatment intervals (medical contact to door, cardiac catheterization laboratory activation, door to balloon, and medical contact to balloon times) were similar between both groups (Table). STEMI complicated by OHA achieved a door to balloon time < 90 minutes and < 60 minutes in 80% and 44% of patients, respectively. Procedural success, measured by achievement of TIMI 3 flow, was similar between both groups. In-hospital mortality was higher in the OHA + STEMI compared to the STEMI group, 41% versus 6%, p <0.0001, respectively.
Conclusions: Despite the critical status of STEMI patients complicated by OHA, treatment intervals and procedural success met current ACC/AHA guidelines. These findings suggest that STEMI complicated by OHA can be effectively treated with primary PCI within a regionalized STEMI care system.
- © 2012 by American Heart Association, Inc.