Urgent coronary angiography and percutaneous coronary intervention as a part of postresuscitation management

Because an acute coronary thrombotic event may be viewed as the main trigger of sudden cardiac arrest, urgent coronary angiography followed by percutaneous coronary intervention appeared as a promising tool in the early postresuscitation phase. Unfortunately, large randomized trials, which have unequivocally demonstrated benefits of urgent percutaneous coronary intervention in patients with acute coronary syndromes, systematically excluded patients with preceding cardiac arrest followed by successful reestablishment of spontaneous circulation. There are several nonrandomized trials in patients with electrocardiographic signs of acute ST-elevation myocardial infarction after reestablishment of spontaneous circulation which together accumulated 478 patients. After urgent coronary angiography, percutaneous coronary intervention was performed in 98%. Patency of infarct-related artery was reestablished in 89%. Success of primary percutaneous coronary intervention and hospital survival in patients regaining consciousness soon after reestablishment of spontaneous circulation appeared to be comparable with ST-elevation myocardial infarction population without preceding cardiac arrest. This is in contrast with comatose survivors of cardiac arrest in whom survival to hospital discharge was, despite somewhat smaller patency of infarct-related artery after percutaneous coronary intervention (94% vs. 82%; p = .12), disproportionably decreased to 57% with good neurologic outcome in only 38%. There is evidence that in these patients, urgent coronary angiography and percutaneous coronary intervention can be safely combined with mild induced hypothermia to facilitate neurologic recovery.