Tag Archives: STEMI

Early cardiac catheterization is associated with improved survival in comatose survivors of cardiac arrest without STEMI

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Early cardiac catheterization is associated with improved survival in comatose survivors of cardiac arrest without STEMI

Resuscitation. Volume 85, Issue 1, January 2014, Pages 88–95

To determine if early cardiac catheterisation (CC) is associated with improved survival in comatose patients who are resuscitated after cardiac arrest when electrocardiographic evidence of ST-elevation myocardial infarction (STEMI) is absent.

Methods
The authors conducted a retrospective observational study of a prospective cohort of 754 consecutive comatose patients treated with therapeutic hypothermia (TH) following cardiac arrest.

Results
A total of 269 (35.7%) patients had cardiac arrest due to a ventricular arrhythmia without STEMI and were treated with TH. Of these, 122 (45.4%) received CC while comatose (early CC). Acute coronary occlusion was discovered in 26.6% of patients treated with early CC compared to 29.3% of patients treated with late CC (p = 0.381). Patients treated with early CC were more likely to survive to hospital discharge compared to those not treated with CC (65.6% vs. 48.6%; p = 0.017). In a multivariate regression model that included study site, age, bystander CPR, shock on admission, comorbid medical conditions, witnessed arrest, and time to return of spontaneous circulation, early CC was independently associated with a significant reduction in the risk of death (OR 0.35, 95% CI 0.18–0.70, p = 0.003).

Conclusions
In comatose survivors of cardiac arrest without STEMI who are treated with TH, early CC is associated with significantly decreased mortality. The incidence of acute coronary occlusion is high, even when STEMI is not present on the postresuscitation electrocardiogram.

http://www.sciencedirect.com/science/article/pii/S0300957213003961

Survival of resuscitated cardiac arrest patients with STEMI conveyed directly to a Heart Attack Centre

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Survival of resuscitated cardiac arrest patients with ST-elevation myocardial infarction (STEMI) conveyed directly to a Heart Attack Centre by ambulance clinicians

© Gary Wilson/ Pre-hospital Research Forum

© Gary Wilson/ Pre-hospital Research Forum

Resuscitation. Available online 19 September 2013

This study reports survival outcomes for patients resuscitated from out-of-hospital cardiac arrest (OHCA) subsequent to ST-elevation myocardial infarction (STEMI), and who were conveyed directly by ambulance clinicians to a specialist Heart Attack Centre for expert cardiology assessment, angiography and possible percutaneous coronary intervention (PCI).

Methods
This is a retrospective descriptive review of data sourced from the London Ambulance Service’s OHCA registry over a one-year period.

Results

The authors observed excellent survival rates for our cohort of patients with 66% of patients surviving to be discharged from hospital, the majority of whom were still alive after one year. Those who survived tended to be younger, to have had a witnessed arrest in a public place with an initial cardiac rhythm of VF/VT, and to have been transported to the specialist centre more quickly than those who did not.

Conclusion
A system allowing ambulance clinicians to autonomously convey OHCA STEMI patients who achieve a return of spontaneous circulation directly to a Heart Attack Centre is highly effective and yields excellent survival outcomes.

http://www.sciencedirect.com/science/article/pii/S0300957213007326

Should we be establishing heart attack centres, similar to stroke centres, to ensure all patients with heart attacks, including those in cardiac arrest, receive optimum treatment, such as cardiologist review, angiography and PCI, or at least ensuring that our patients are conveyed to hospitals with these facilities?
Achieving a rate of 66% for patients surviving to discharge, with the majority of whom were still alive after one year, could suggest that that this is a good idea.