Emergency percutaneous coronary intervention in patients with ST-elevation myocardial infarction complicated by out-of-hospital cardiac arrest: Early and medium-term outcome

Received 1 September 2008; accepted 26 October 2008. published online 22 December 2008.

Background

The role of emergency reperfusion therapy in patients with ST-elevation myocardial infarction (STEMI) resuscitated after an out-of-hospital cardiac arrest (OHCA) has not been clearly established yet. The aim of this study was to evaluate the in-hospital and postdischarge outcomes of STEMI patients surviving OHCA and undergoing emergency angioplasty (percutaneous coronary intervention [PCI]) within an established regional network.

Methods

We prospectively collected data on 2,617 consecutive patients with STEMI treated with emergency PCI in 2005; in-hospital and 6-month outcomes of 99 patients who had experienced OHCA were compared with those of 2,518 patients without OHCA. The OHCA patients also underwent a cerebral performance evaluation after 12 months.

Results

OHCA patients were at higher clinical risk at presentation (cardiogenic shock 26% vs 5%, P < .0001). Percutaneous coronary intervention was successful in 80% of the OHCA and 89% of the non-OHCA patients (P = NS). In-hospital mortality rates were 22% and 3%, respectively (P < .0001). Independent predictors of in-hospital mortality among OHCA patients were longer delay between the call to the emergency medical system and the start of cardiopulmonary resuscitation (odds ratio [OR] 3.5, P = .03), nonshockable initial rhythms (OR 10.5, P = .002), cardiogenic shock (OR 3.05, P = .035), and a Glasgow Coma Scale score of 3 on admission (OR 2.9, P = .032). The 6-month composite rate of death, myocardial infarction, and revascularization among OHCA patients surviving the acute phase was comparable to that of non-OHCA patients (16% vs 13.9%, P = NS), and 87% of them showed a favorable neurologic recovery after 1 year.

Conclusions

Resuscitated OHCA patients undergoing emergency PCI for STEMI have worse clinical presentation and higher in-hospital mortality compared to those without OHCA. However, subsequent cardiac events are similar, and neurologic recovery is more favorable than reported in most previous series.

a Department of Cardiology, Ospedale Carlo Poma, Mantova, Italy

b Department of Cardiology, Ospedale Niguarda Ca' Granda, Milano, Italy

c Department of Cardiology, Ospedale Civile, Legnano, Italy

d Department of Cardiology, Ospedali Riuniti, Bergamo, Italy

e Department of Cardiology, Istituto Clinico Humanitas, Rozzano, Italy

f Department of Cardiology, Policlinico San Matteo, Pavia, Italy

g Department of Cardiology, Ospedale Sacco, Milano, Italy

h Department of Cardiology, Ospedale Moriggia-Pelascini, Gravedona, Italy

i Department of Cardiology, Ospedali Civili, Brescia, Italy

j Department of Cardiology, Ospedale di Circolo, Varese, Italy

k Department of Cardiology, Centro Cardiologico Monzino, Milano, Italy

l Department of Cardiology, Policlinico San Marco, Zingonia, Italy

m Department of Cardiology, Ospedale San Raffaele, Milano, Italy

n Department of Cardiology, Ospedale di Circolo, Busto Arsizio, Italy

o Department of Cardiology, Istituti Ospedalieri, Cremona, Italy.

Reprint requests: Corrado Lettieri, MD, Department of Cardiology, Carlo Poma Hospital, Viale Albertoni 1, 46100 Mantova, Italy.

r See Appendix A for the complete group of the LombardIMA Study Group.

PII: S0002-8703(08)00909-5

doi:10.1016/j.ahj.2008.10.018

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