Key result
Resuscitated out-of-hospital cardiac arrest in paramedic-identified STEMI patients treated with primary PCI was associated with a one-year mortality of 5.2%, compared to 3.3% in those without OHCA.
Why the study?
Data are lacking on the prognosis of STEMI patients after OHCA who are diagnosed and treated by paramedics before transport for primary PCI.
Does resuscitated out-of-hospital cardiac arrest affect survival and clinical profiles in paramedic-identified STEMI patients treated with primary PCI compared to those without OHCA?
Cohort
Does resuscitated out-of-hospital cardiac arrest affect survival and clinical profiles in paramedic-identified STEMI patients treated with primary PCI compared to those without OHCA?
Absolute Event Rate: 5.2% vs 3.3%
High survival supports urgent PCI after paramedic-identified STEMI-OHCA; extends observational data but leaves optimal strategies open.
Background: ST-segment elevation myocardial infarction (STEMI) is a common cause of out-of-hospital cardiac arrest (OHCA). For these patients, urgent angiography and revascularization is an important treatment goal. There is a lack of data on the prognosis of STEMI patients after OHCA, who are diagnosed and treated by paramedics prior to hospital transport for primary percutaneous coronary intervention (PCI).Methods: Included were adult STEMI patients identified and treated by paramedics in Queensland (Australia) from January 2016 to December 2019, transported to a hospital for primary PCI, and receiving primary PCI. Patients were grouped into those with resuscitated OHCA and those without OHCA. Clinically-important time intervals, angiographic and clinical profiles, and survival were described.Results: Patients with OHCA had longer time intervals from prehospital STEMI identification to reperfusion than those without OHCA (median 97 versus 87 mins, p = 0.001). The former had higher rates of cardiac arrhythmia history (50.5 versus 12.4%, p < 0.001), classified low left ventricular ejection fraction on admission (64.9 versus 50.1%, p = 0.006), and cardiogenic shock (5.2 versus 1.2%, p = 0.011) than the latter. A significantly higher proportion of patients with OHCA had multiple diseased vessels (16.9 versus 8.3%, p = 0.005). In-hospital, 30-day, and one-year mortality was low, being 4.1%, 4.1% and 5.2%, respectively, for STEMI patients with OHCA. The corresponding figures for those without OHCA were 1.6%, 1.8% and 3.3%, respectively.Conclusions: Survival in paramedic-identified STEMI patients treated with primary PCI following OHCA resuscitation was high. Rapid angiography and reperfusion are critical in these patients.
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Doan et al. (2021) conducted a cohort in ST-segment elevation myocardial infarction (STEMI). Resuscitated out-of-hospital cardiac arrest (OHCA) vs. No OHCA was evaluated on One-year mortality. Resuscitated out-of-hospital cardiac arrest in paramedic-identified STEMI patients treated with primary PCI was associated with a one-year mortality of 5.2%, compared to 3.3% in those without OHCA.
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