Patients without ST elevation after return of spontaneous circulation may benefit from emergent percutaneous...

Area of Science:

• Cardiology
• Emergency Medicine
• Interventional Cardiology

Background:

• American Heart Association guidelines recommend emergent percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) post-cardiac arrest.
• Recommendations for emergent PCI in post-arrest patients without ST-elevation are less defined.
• This review addresses the utility of PCI in non-ST-elevation post-arrest patients.

Purpose of the Study:

• To systematically review the literature on the utility of emergent PCI in post-cardiac arrest patients without ST-elevation.
• To compare the benefit of PCI in post-arrest patients with and without ST-elevation myocardial infarction (STEMI).
• To determine the percentage of non-STEMI post-arrest patients who benefit from emergent PCI due to acute culprit coronary lesions.

Main Methods:

• A systematic review of English language literature was conducted.
• The review covered all years up to March 1, 2015.
• Data from 11 identified articles were analyzed to assess the study hypothesis.

Main Results:

• Patients with STEMI were 13.8 times more likely to undergo emergent catheterization compared to those without STEMI.
• In post-arrest patients without ST-elevation, 32.2% had an acute culprit lesion requiring intervention.
• In post-arrest patients with STEMI, 71.9% had an acute culprit lesion requiring intervention.

Conclusions:

• Nearly one-third of successfully resuscitated cardiopulmonary arrest patients without ST-elevation on ECG have an acute lesion.
• These acute lesions in non-ST-elevation patients would benefit from emergent percutaneous coronary intervention (PCI).
• The findings support considering emergent PCI in select post-cardiac arrest patients presenting without ST-elevation.