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

Savonitto, Stefano; Servi, Stefano De; Guagliumi, Giulio; Belli, Guido; Repetto, Alessandra; Piccaluga, Emanuela; Politi, Alessandro; Ettori, Federica; Castiglioni, Battistina; Fabbiocchi, Franco; Cesare, Nicoletta De; Sangiorgi, Giuseppe; Musumeci, Giuseppe; Onofri, M; D’Urbano, Maurizio; Pirelli, Salvatore; Zanini, Roberto; Klugmann, Silvio

doi:10.1016/j.ahj.2008.10.018

Cited by 101 publications

(57 citation statements)

References 23 publications

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“…Of note, consciousness disturbance on hospital arrival was a strong predictor of 30-day mortality. A Glasgow coma scale of 3 was reported as a predictor of inhospital mortality in patients with OHCA caused by ACS; 38 however, there are little data about the effect of consciousness disturbance on hospital arrival on the outcome of patients with cardiovascular shock. Although congestive heart failure was reported as a variable associated with poor mortality in patients with ACS, 15,39 our results underscore heart failure as an important determinant of prognosis in patients with shock may have been associated, at least partly, with immediate use of antiarrhythmic drugs, defibrillation, and temporary pacing in the emergency room.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and Predictors of Mortality in Patients With Cardiovascular Shock in Japan　– Results From the Japanese Circulation Society Cardiovascular Shock Registry –

Ueki

Mohri

Matoba

et al. 2016

Circ J

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Section: Discussionmentioning

confidence: 99%

Characteristics and Predictors of Mortality in Patients With Cardiovascular Shock in Japan　– Results From the Japanese Circulation Society Cardiovascular Shock Registry –

Ueki

Mohri

Matoba

et al. 2016

Circ J

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“…25) Resuscitated OHCA patients with STEMI have a higher risk of cardiogenic shock and in-hospital mortality even after undergoing primary PCI. 26) Longer delay in the start of cardiopulmonary resuscitation (CPR) in OHCA is an important predictor of in-hospital mortality. Increasing the by-stander CPR rate, which is still low in Taiwan, plays a critical role in improving survival in these patients.…”

Section: Discussionmentioning

confidence: 99%

Analysis of the Clinical Characteristics, Management, and Causes of Death in Patients with ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention from 2005 to 2014

et al. 2016

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SummaryIt is unknown whether there has been any change in the causes of death for acute ST-segment elevation myocardial infarction (STEMI) in the era of aggressive reperfusion. We analyzed the direct causes of in-hospital death in patients with STEMI treated with primary percutaneous coronary intervention (PCI) in a tertiary referral center over the past 10 years.We retrospectively analyzed 878 STEMI patients treated with primary PCI in our hospital between January 2005 and December 2014. There were no significant changes in the age and sex of patients, but the prevalence of hypertension and smoking decreased. STEMI severity increased with more patients in Killip classification > 2. The number of out-ofhospital cardiac arrest events also increased over the 10 years. Symptom onset-to-door time did not change in the 10-year study period. The care quality was improved with shorter door-to-balloon time for primary PCI and increased use of dual antiplatelet therapy. The all-cause in-hospital mortality was 9.1%, which did not vary over the 10 years. Multivariable analysis showed that Killip classification > 2 was the most important determinant of death. Cardiogenic shock was the major cause of cardiovascular death. There was an increase in non-cardiovascular causes of death in the most recent 3 years, with infection being a major problem.Despite improvement in care quality for STEMI, the in-hospital mortality did not decrease in this tertiary referral center over these 10 years due to increased disease severity and non-cardiovascular causes of death. (Int Heart J 2016; 57: 541-546) Key words: Acute myocardial infarction, Coronary angioplasty, Mortality A cute myocardial infarction is an important public health issue in Taiwan because it carries a high fatality rate and its incidence is still increasing. 1) In acute ST-segment elevation myocardial infarction (STEMI), timely primary percutaneous coronary intervention (PCI) and the use of evidence-based medications significantly decrease mortality, and are strongly recommended in local 2) and international guidelines.3,4) In Taiwan, more than 95% of STEMI patients received primary PCI as the initial reperfusion therapy, and the door-to-balloon (D2B) time has improved. 5,6) A previous observational study demonstrated that early primary PCI could decrease the incidence of cardiogenic shock, which is the major cause of death in STEMI.7) It is unknown whether there has been any temporal change in the causes of death during hospitalization for STEMI with the advent of aggressive reperfusion in recent years. Information on the specific causes of death can reveal the weak points of current treatment and enable the implementation of new strategies to improve the quality of care for STEMI patients treated with primary PCI. The major aims of the present study were to describe the 10-year secular trends in the clinical characteristics and management of STEMI patients treated with primary PCI, and to specifically analyze the causes of death in these patients in a tertiary referral c...

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“…Five of 7 patients not surviving to discharge died from cardiogenic shock, 1 after out-of-hospital cardiac arrest and 1 after development of severe sepsis, all conditions associated with significantly higher in-hospital mortality rates. [38][39][40] Further data acquisition and analysis over a longer time period will be required to determine a true survival benefit from our Heart Alert protocol.…”

Section: Discussionmentioning

confidence: 99%

Factors Contributing to Door-to-Balloon Times of ≤90 Minutes in 97% of Patients with ST-Elevation Myocardial Infarction: Our One-Year Experience with a Heart Alert Protocol

Levis

Mercer²,

Thanassi³

et al. 2010

permj

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Context: Prompt percutaneous coronary intervention (PCI) for patients with ST-segment elevation myocardial infarction (STEMI) can significantly reduce mortality and morbidity, although its effectiveness may be limited by delays in delivery. In March 2008, our hospital implemented a Heart Alert protocol to rapidly identify and treat patients with STEMI presenting to our Emergency Department (ED) with PCI, using strategies previously described to reduce door-to-balloon times. Before the Heart Alert protocol start date, patients with STEMI presenting to our ED were treated with thrombolysis.Objective: We evaluated data from patients with STEMI after one year of use of our Heart Alert protocol to determine protocol success on the basis of the percentage of patients for whom the recommended door-to-balloon times of ≤90 minutes were met. We examined factors involved in implementation of the protocol that contributed to these results.Design: We conducted a retrospective data and chart review for patients in the ED with STEMI who underwent PCI after a Heart Alert protocol activation between March 17, 2008, and March 17, 2009.Results: During the study period, our staff met the recommended door-to-balloon time of ≤90 minutes (mean door-to-balloon time, 57.3 ± 17.6 minutes) for 70 of 72 patients (97%) presenting to our ED with STEMI. Sixty-five of the 72 patients (90.3%) survived to hospital discharge.Conclusion: Initiation of a Heart Alert protocol at our hospital resulted in achievement of door-to-balloon times of ≤90 minutes for 97% of patients with STEMI. This achievement was obtained through careful preparation, training, and interdepartmental collaboration and occurred despite immediate conversion from a previous thrombolytic protocol.

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

Cited by 101 publications

References 23 publications

Characteristics and Predictors of Mortality in Patients With Cardiovascular Shock in Japan　– Results From the Japanese Circulation Society Cardiovascular Shock Registry –

Characteristics and Predictors of Mortality in Patients With Cardiovascular Shock in Japan　– Results From the Japanese Circulation Society Cardiovascular Shock Registry –

Analysis of the Clinical Characteristics, Management, and Causes of Death in Patients with ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention from 2005 to 2014

Factors Contributing to Door-to-Balloon Times of ≤90 Minutes in 97% of Patients with ST-Elevation Myocardial Infarction: Our One-Year Experience with a Heart Alert Protocol

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

Cited by 101 publications

References 23 publications

Characteristics and Predictors of Mortality in Patients With Cardiovascular Shock in Japan – Results From the Japanese Circulation Society Cardiovascular Shock Registry –

Characteristics and Predictors of Mortality in Patients With Cardiovascular Shock in Japan – Results From the Japanese Circulation Society Cardiovascular Shock Registry –

Analysis of the Clinical Characteristics, Management, and Causes of Death in Patients with ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention from 2005 to 2014

Factors Contributing to Door-to-Balloon Times of ≤90 Minutes in 97% of Patients with ST-Elevation Myocardial Infarction: Our One-Year Experience with a Heart Alert Protocol

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Characteristics and Predictors of Mortality in Patients With Cardiovascular Shock in Japan　– Results From the Japanese Circulation Society Cardiovascular Shock Registry –

Characteristics and Predictors of Mortality in Patients With Cardiovascular Shock in Japan　– Results From the Japanese Circulation Society Cardiovascular Shock Registry –