Long-term prognosis after out-of-hospital cardiac arrest and primary percutaneous coronary intervention
Introduction
The prognosis after out-of-hospital cardiac arrest is generally poor due to cerebral and cardiac injury. The majority (80–90%) of these patients suffer from critical stenosis or acute occlusion of the coronary vessels and one important goal of treatment is therefore to achieve adequate reperfusion rapidly and normalization of the haemodynamics [1], [2]. To address the importance of this issue, we hypothesised that long-term survival of survivors of out-of-hospital cardiac arrest and acute myocardial infarction may be dependent on the degree of myocardial salvage (i.e. coronary reperfusion). During the last decade several reports have shown that primary percutaneous coronary intervention (PCI) is safe and restores blood flow in over 95% of the patients with acute ST-segment elevation myocardial infarction (STEMI) [3], [4], [5], [6].
Survivors of cardiac arrest with STEMI, treated with PCI, should in theory have the same prognosis as other STEMI patients treated with PCI. However, the prognosis may also be influenced by non-cardiac organ damage (e.g. brain, kidneys, lungs) due to prolonged cardiopulmonary resuscitation (CPR). The aim of the present study was to observe the long-term survival after out-of-hospital cardiac arrest and successful CPR in patients with STEMI treated with PCI. In-hospital and long-term mortality (i.e. 2 years) was compared with that of a reference group of STEMI patients treated with primary PCI.
Section snippets
Design
Over 3 years (May 1998–May 2001), we have followed prospectively 40 consecutive patients admitted to our hospital after successful out-of-hospital CPR with STEMI. The patients were treated with primary PCI and in-hospital and 2-year mortality were compared with that of a reference group of 325 consecutive patients with STEMI treated with primary PCI in the same period.
Logistics
The study was conducted in Oslo with a population of approximately 5 10 000 and a land area of 427 km2. A one-tiered centralised
Study population
From May 1998 to May 2001 32 male and 8 female patients were treated with primary PCI after successful out-of-hospital CPR and STEMI. The total number of patients admitted to our hospital after successful out-of-hospital CPR in the same period was 144. Six of the patients had unwitnessed cardiac arrest, but this was not recognized before treatment with primary PCI. Mean age was 54 years (range 25–83). Ventricular fibrillation was the first arrhythmia detected in 90% of the patients, and
Discussion
The prognosis after out-of-hospital cardiac arrest is poor but it has been shown that early onset of CPR and defibrillation are the most important factors to improve the outcome [8], [10], [11]. Theoretically, achieving rapid and adequate coronary reperfusion should be another important strategy since the majority of the patients with out-of-hospital cardiac arrest suffer from acute coronary ischaemia (i.e. critical stenosis or acute occlusion) [1], [2]. The importance of coronary reperfusion
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