Out-of-Hospital Cardiac Arrests in Patients with Acute ST Elevation Myocardial Infarctions in the East Bohemian Region over the Period 2002–2004

Abstract

Background: Early reperfusion by direct percutaneous coronary intervention (PCI) in patients with ST segment elevation acute myocardial infarctions (STEMI) with an out-of-hospital cardiac arrest (OHCA) reduces hospital and longterm mortality. Aims: Evaluating the significance of direct PCI for the short-term (discharge from acute hospitalization) and 1-year survival in patients with acute STEMI after OHCA. Methods: In this prospective study, from April 1, 2002 up to August 31, 2004, a total of 26 hospitalized individuals (22 men, 4 women, aged 35–79 years, median 58.5) from the East Bohemian region with OHCA (primary group of 718 individuals) with acute STEMI were included. Urgent coronary angiography was performed in 20 individuals, and direct PCI was done in 19 of them. The remaining 6 patients did not undergo angiography. Results: Fifteen patients (57.7%) survived acute hospitalization, of whom 11 were without neurological deficits. In the subgroup with urgent coronary angiography 14 patients (70%) survived hospitalization, and in the subgroup without coronarography only 1 patient survived hospitalization (16.7%). In the subgroup with PCIs, 13 out of the 19 patients survived (68.4%). None of the patients died during the 1-year follow-up after being discharged from acute hospitalization. According to the urgent coronarography the artery most commonly responsible for the infarction was the left anterior descending artery (50%). Initial TIMI flow grade 0–I was found in 17 patients and grade II–III in 3 individuals. After PCI, irrespective of stent implantation, an optimal angiographic success (TIMI flow grade II–III) was obtained in 17 cases. Conclusion: Short-term survival of patients after OHCA with STEMI treated with direct PCI was found to be 68.4%. Out of 6 patients not receiving reperfusion therapy 1 survived (16.7%). Over the course of the 1-year follow-up none of the patients died.

Part 10: Acute Coronary Syndromes

“…PCI is feasible following ROSC, and almost 50% of cardiac arrest survivors have an acute thrombotic occlusion, or culprit lesion, that is amenable to reperfusion. 217,[221][222][223][224][225][226][227][228][229][230][231][232][233][234][235] In addition, successful PCI can result in improved cardiac ejection fraction and survival. 217 Cardiac catheterization alone (without PCI) has been associated with improved neurologically intact survival.…”

Out-of-Hospital Cardiac Arrest Resuscitation Systems of Care: A Scientific Statement From the American Heart Association

“…79,80 Access to PCI Up to 70% of patients with OHCA have coronary artery disease. Although 50% have acute coronary occlusion, [81][82][83][84][85][86][87][88][89][90][91] only a minority of patients with OHCA with ROSC who were transported to hospital have an ST-segment elevation on a 12-lead ECG. 92,93 Mortality after emergent angiography for STEMI patients in the setting of post-ROSC OHCA is greater than that in the setting of STEMI alone.…”

Impact of Percutaneous Coronary Intervention Performance Reporting on Cardiac Resuscitation Centers

“…Accumulating clinical data now show that up to 70% of OHCA patients have coronary artery disease, and nearly half have an acute coronary occlusion. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] These data underscore the importance of early coronary angiography, and reperfusion in these patients is likely similar to that in STEMI patients who have not had a CA.…”

“…13 This 50% survival is double the previous long-term survival rate before such aggressive bundled postarrest care was used. 13 Such an aggressive postarrest revascularization approach [5][6][7][8][9][10][12][13][14][15][16][17][18][19][20][21] has the unintended consequence of causing the centers that perform the type of highvolume, quality postarrest care that follows a Class I AHA guideline to have significantly higher mortality than hospitals that treat only a few postarrest patients annually. Appropriate subsets of postarrest patients being given immediate access to the catheterization laboratory involves treating many patients who will ultimately succumb to neurological or multiorgan failure rather than a cardiovascular death, 22 yet their deaths are reported simultaneously with all other STEMI patients, the majority of whom have a 10-fold lower periprocedural mortality.…”