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Clinical Articles, News & Views

Coronary angioplasty improves cardiac arrest survival

Coronary angioplasty improves survival in all patients with out of hospital cardiac arrest, according to research1 presented at the Acute Cardiac Care Congress 2012, held recently in Istanbul.

Researchers led by Dr Annamaria Nicolino (Santa Corona General Hospital, Pietra Ligure, Italy) aimed to discover whether performing urgent coronary angiography, and percutaneous coronary intervention (PCI) if required, would improve survival in all patients with out of hospital cardiac arrest (both those with ST elevation and those without).

The study included 70 patients who had out of hospital cardiac arrest between 2006 and 2009. Successful urgent coronary angiography and PCI improved hospital survival in all patients with acute coronary syndrome. The treatment increased hospital survival rates in patients with ST elevation myocardial infarction (STEMI) from 51% to 83% and in non-STEMI (NSTEMI) patients from 55% to 81%.

Post-resuscitation neurologic injury (PNI) was the biggest complication. The 32.8% of patients who had PNI were at the greatest risk of death. Early signs of PNI were associated with underuse of coronary angioplasty and PCI.

Provided there was no neurological injury, MI patients who had angioplasty after cardiac arrest achieved the same one-year survival rates as patients with MI alone.

The first heart rhythm was a ventricular fibrillation (VF) or a ventricular tachycardia (VT) in 62% of patients. Most of these patients had an acute coronary syndrome (STEMI or NSTEMI). The incidence of VF and VT was the same in STEMI and NSTEMI patients.

Dr Nicolino said: “There is controversy about what to do when a patient with out of hospital cardiac arrest has a normal ECG that does not show ST elevation. ESC Clinical Practice Guidelines are inconclusive – they say to consider performing coronary angiography but they don’t say ‘do it’ or ‘don’t do it’.”

“In our study, a successful urgent coronary angioplasty improved hospital survival in patients with STEMI and NSTEMI,” said Dr Nicolino. “All patients with out of hospital cardiac arrest, if there is no non-cardiac cause, must have an urgent coronary angiography followed by coronary angioplasty if there is coronary disease.”

“For many years we have thought that patients with STEMI have a greater arrhythmic risk than NSTEMI patients,” said Dr Nicolino. “But we found that both STEMI and NSTEMI patients are at high risk of arrhythmias.”

She added: “If the first recorded rhythm is a VF or a VT an acute coronary syndrome is highly probable and it’s important to perform a coronary angiography immediately without waiting for a diagnosis of infarction (using an enzyme test).”

Dr Nicolino concluded: “Patients with out of hospital cardiac arrest must be managed by cardiologists, intensive care doctors and anaesthesiologists. This team can save the brain from injury using cooling therapy, and save the heart and life of the patient using coronary angioplasty”.

References

1. Nicolino A, Moshiri S, Olivotti L, et al. Urgent invasive strategy for out-of-hospital cardiac arrest survivors is associated with better survival. Eur Heart J: Acute Cardiovascular Care Abstract Supplement 2012;1(S1):140.

Published on: October 19, 2012

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ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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