ST-Segment Elevation Myocardial Infarction and Out-of-Hospital Cardiac Arrest: Contemporary Management From the
Meena Zareh, Jeffrey J Rade, Joseph L Thomas
1Division of Cardiovascular Medicine, University of Southern California, 1510 San Pablo Street, Suite 322, Los Angeles, CA 90033 USA. shavelle@usc.edu.
Insights
Primary percutaneous coronary intervention (PCI) and targeted temperature management (TTM) show high survival and good neurologic outcomes in ST-elevation myocardial infarction (STEMI) patients after out-of-hospital cardiac arrest (OHCA). This study highlights key predictors for successful recovery in these critical patients.
Area of Science:
- Cardiology
- Neurology
- Emergency Medicine
Background:
- ST-segment elevation myocardial infarction (STEMI) complicated by out-of-hospital cardiac arrest (OHCA) presents a critical clinical challenge.
- Emerging evidence suggests primary percutaneous coronary intervention (PCI) and targeted temperature management (TTM) improve outcomes in these patients.
- Characterizing contemporary treatment approaches and neurologic outcomes is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate treatment strategies and identify predictors of neurologic outcome in a contemporary series of STEMI patients with OHCA.
- To assess the effectiveness of primary PCI and TTM in this high-risk patient population.
- To determine factors associated with in-hospital survival and good neurologic function.
Main Methods:
- A multicenter registry enrolled 239 patients with STEMI and OHCA from January 2009 to November 2012.
- Patients underwent emergent coronary angiography and revascularization.
- Neurologic outcome was assessed using the Cerebral Performance Category (CPC) score, with logistic regression used to identify predictors.
Main Results:
- The study included 239 patients (mean age 60±13 years, 72% male) with STEMI and OHCA.
- Primary PCI was performed in 74% of patients, and TTM was utilized in 51%.
- Good neurologic function (CPC score 1 or 2) was achieved in 55% of patients, with an overall in-hospital survival rate of 66%.
Conclusions:
- Contemporary management including emergent coronary angiography, revascularization, and TTM in STEMI patients with OHCA is associated with high short-term survival.
- More than half of the patients experienced good neurologic outcomes, underscoring the effectiveness of current treatment protocols.
- Bystander CPR, arrest location, drug-eluting stent use, and absence of recurrent cardiac arrest were independent predictors of survival with good neurologic function.
Background:
Recent studies suggest that primary percutaneous coronary intervention (PCI) and targeted temperature management (TTM) improve outcome in ST-segment elevation myocardial infarction (STEMI) complicated by out-of-hospital cardiac arrest (OHCA). The objective of this study was to evaluate a contemporary series of patients with STEMI and OHCA to characterize treatment approaches and predictors of neurologic outcome.
Methods:
From January 2009 through November 2012, a total of 239 patients who underwent emergent coronary angiography at 10 medical centers across the United States were enrolled. All patients suffered OHCA with STEMI on either the prehospital or post-resuscitation electrocardiogram. Neurologic outcome was assessed using the cerebral performance category (CPC) score. Predictors of neurologic outcome were determined using multivariate logistic regression analysis. The primary endpoint was in-hospital survival with good neurologic function (CPC score 1 or 2).
Results:
Mean age was 60 ± 13 years, 72% were male, and the majority of patients had a history of cardiovascular event. Initial rhythm was ventricular fibrillation in 72%. At hospital presentation, 76% of patients were intubated, 37% were in cardiogenic shock, and 33% were receiving vasopressors. Primary PCI was performed in 74%, with an average door-to-balloon time of 95 ± 77 minutes, and TTM was used in 51%. Forty-four percent of patients had full neurologic recovery (CPC score 1) and 55% had good neurologic function. Overall in-hospital survival rate was 66%. Independent predictors of in-hospital survival with good neurologic function were: receiving bystander cardiopulmonary resuscitation, location of arrest, receiving drug-eluting stents, and not experiencing a recurrent cardiac arrest.
Conclusions:
Short-term survival for patients with STEMI and OHCA undergoing emergent coronary angiography and revascularization with TTM in this contemporary, multicenter registry was high and neurologic outcome was good in more than half of patients.
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