Out-of-hospital cardiac arrest and percutaneous coronary intervention for ST-elevation myocardial infarction: Long-term survival and neurological outcome

Zimmermann S, Flachskampf FA, Alff A, Schneider R, Dechant K, Klinghammer L, Stumpf C, Zopf Y, Loehr T, Brand G, Ludwig J, Daniel W, Achenbach S (2013)

Publication Type: Journal article

Publication year: 2013

Journal

International Journal of Cardiology Elsevier

Book Volume: 166

Pages Range: 236-241

Journal Issue: 1

DOI: 10.1016/j.ijcard.2011.11.029

Abstract

Background: Predictors of long-term outcome after ST-elevation myocardial infarction (STEMI) complicated by out-of-hospital cardiac arrest (OHCA) are incompletely understood, including the influence of successful coronary reperfusion. Methods: We analysed clinical and procedural data as well as 1-year outcome of 72 consecutive patients who underwent primary coronary intervention (PCI) after witnessed OHCA and STEMI and compared the results with 695 patients with STEMI and PCI, but without OHCA. Neurological recovery after OHCA was assessed using the Cerebral Performance Category (CPC) scale. Results: PCI was successful in 83.3% after OHCA vs. 84.3% in the non-OHCA group (p = 0.87). One-year mortality was 34.7% vs. 9.5% (p < 0.001). 58.3% of the OHCA-patients showed complete neurological recovery (CPC 1) or moderate neurological disability (CPC 2). Another 6.9% showed severe cerebral disability (CPC 3) or permanent vegetative status (CPC 4). Delay from collapse until start of Advanced Cardiopulmonary Life Support (ACLS) was shorter for survivors with CPC status ≤ 2 (median 1 min, range 0-11 min) compared to non-survivors or survivors with CPC status > 2 (median 8 min, range 0-13 min), p < 0.0001. Age-adjusted multivariate analysis identified 'unsuccessful PCI', 'vasopressors on admission' and 'start of ACLS after > 6 min' as independent predictors of negative long-term outcome (death or CPC > 2). Conclusions: Mortality is high in patients with STEMI complicated by OHCA - even though PCI was performed with the same success rate as in patients without OHCA. The majority of survivors had favourable neurological outcomes at 1 year, especially if advanced life support had been started within ≤ 6 min and PCI was successful. © 2011 Elsevier Ireland Ltd.

Authors with CRIS profile

Stefan Zimmermann Institut für Lehre und Forschung am Medizincampus Oberfranken Katharina Dechant Medizinische Fakultät Lutz Klinghammer Department of Medicine 2 – Cardiology and Angiology Christian Stumpf Department of Medicine 2 – Cardiology and Angiology Yurdagül Zopf Professur für Integrative Medizin mit dem Schwerpunkt Ernährungsmedizin (Stiftungsprofessur der Hector Stiftung II gGmbH) Josef Ludwig Medizinische Fakultät Werner Daniel Medizinische Fakultät Stephan Achenbach Lehrstuhl für Innere Medizin II

Involved external institutions

Uppsala University SE Sweden (SE)

How to cite

APA:

Zimmermann, S., Flachskampf, F.A., Alff, A., Schneider, R., Dechant, K., Klinghammer, L.,... Achenbach, S. (2013). Out-of-hospital cardiac arrest and percutaneous coronary intervention for ST-elevation myocardial infarction: Long-term survival and neurological outcome. International Journal of Cardiology, 166(1), 236-241. https://doi.org/10.1016/j.ijcard.2011.11.029

MLA:

Zimmermann, Stefan, et al. "Out-of-hospital cardiac arrest and percutaneous coronary intervention for ST-elevation myocardial infarction: Long-term survival and neurological outcome." International Journal of Cardiology 166.1 (2013): 236-241.

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