Percutaneous coronary intervention outcomes following out-of-hospital cardiac arrest for patients with and without ST-elevation myocardial infarction.

Abstract

Background: Outcomes after out-of-hospital cardiac arrest (OHCA) remain poor, and percutaneous coronary intervention (PCI) may have prognostic benefit in patients with a culprit coronary lesion. We aimed to describe outcomes among patients undergoing PCI following OHCA and the effect of ST-elevation myocardial infarction on outcome. Methods: Data were prospectively collected on 1,047 consecutive PCI procedures following OHCA at six Victorian public hospitals from 2005 to 2017. Patients were divided into those with STEMI (OHCA-S) and those without (OHCA-NS). Outcomes were compared against patients with STEMI only without OHCA ( n = 9,694). Results: OHCA-S patients were younger and the treated lesion was more commonly occluded at time of PCI (63% vs 22%, p < 0.001). GP-IIb/IIIa antagonists, thrombus aspiration and intra-aortic balloon pump insertion were more frequently used for OHCA-S ( p < 0.01). Cardiogenic shock (CS) was present in 47% of OHCA-S and 29% of OHCA-NS ( p < 0.001). 30-day mortality was 34% for the OHCA-S and 18% for the OHCA-NS group. However, OHCA-S and OHCA-NS had similar long-term outcomes to the STEMI only group if they survived to 30-days. Multivariable predictors for 30-day mortality after PCI for OHCA were diabetes, impaired renal or LV function, and CS. Conclusions: PCI following OHCA has a high 30-day mortality, with worse outcomes among patients with STEMI. Beyond 30-days, long-term outcomes are similar to uncomplicated STEMI cohorts.