Key result
Pre-PCI cardiac arrest in STEMI is linked to a ~4-fold higher one-month mortality from noncardiac causes.
Why the study?
The poor prognosis of primary PCI in STEMI patients resuscitated from cardiac arrest may be partly explained by cardiogenic shock, but outcomes in those without shock are unclear.
Cohort (n=948)
Answers are grounded in this paper and cite their sources.
Similar cardiac mortality after emergency PCI in resuscitated arrest versus non-arrest STEMI without shock; observational data leaves open need for randomized confirmation.
BACKGROUND: The poor prognosis of primary percutaneous coronary intervention (PCI) in patients resuscitated from cardiac arrest complicating acute ST-segment elevation myocardial infarction (STEMI) may at least partly be explained by the common presence of cardiogenic shock. This study examined the impact of emergency primary PCI on outcome in patients with STEMI not complicated by cardiogenic shock who were resuscitated from cardiac arrest. METHODS AND RESULTS: The study group included 948 consecutive patients without cardiogenic shock who underwent emergency primary PCI from 2001 to 2006 for STEMI. Twenty-one of them were resuscitated from cardiac arrest before the intervention. Data on background, clinical characteristics, and outcome were prospectively collected. There were no differences between the resuscitated and nonresuscitated patients in age, sex, infarct location, or left ventricular function. The total one-month mortality rate was higher in the resuscitated patients (14.3 vs. 3.4%, P=0.033), but noncardiac mortality accounted for the entire difference (14.3 vs. 1.2%, P=0.001), whereas cardiac mortality was similarly low in the two groups (0 vs. 2.0%, P=NS). Predictors of poor outcome in the resuscitated patients were older age (r=0.47, P=0.032), unwitnessed sudden death (r=0.44, P=0.04), longer interval between onset of cardiac arrest and arrival of a mobile unit (r=0.67, P=0.001) or to spontaneous circulation (r=0.65, P=0.001), low glomerular filtration rate (r=-0.50, P=0.02), and the initial thrombolysis in myocardial infarction grade of flow (r=-0.51, P=0.017). CONCLUSION: Emergency PCI for STEMI not associated with cardiogenic shock exerts a similar effect on cardiac mortality in patients who were resuscitated from cardiac arrest and in those without this complication. The higher all-cause mortality rate among resuscitated patients is explained by noncardiac complications.
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Mager et al. (2008) conducted a cohort in Acute ST-elevation myocardial infarction (STEMI) without cardiogenic shock (n=948). Cardiac arrest requiring resuscitation prior to PCI vs. No cardiac arrest (nonresuscitated) was evaluated on Total one-month mortality rate (p=0.033). Cardiac arrest requiring resuscitation before emergency PCI for STEMI without cardiogenic shock was associated with higher one-month mortality (14.3% vs 3.4%, P=0.033) due to noncardiac deaths.
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