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32 Outcomes of PCI in mechanically-ventilated survivors of cardiac arrest: the view from wales
  1. A Hailan1,
  2. R Khatun2,
  3. M Khanji1,
  4. C Battle2,
  5. P Temblett1,
  6. O Bodger3,
  7. T Kinnaird2,
  8. A Ionescu1
  1. 1Morriston Regional Cardiac Centre
  2. 2University Hospital of UK
  3. 3Institute of Life Sciences, Swansea University

Abstract

Background Whether to subject comatose survivors of cardiac arrest to cardiac catheterisation is a difficult question. ST-segment elevation (STE) is absent in 20% of proven STEMIs while concerns about long-term outcomes can inhibit invasive strategies.

Methods We identified in the cath lab databases of the 2 Welsh tertiary centres those patients who arrived on respiratory support after a cardiac arrest and had PCI between 01/03/07–28/02/14 (UHW and MCC), and collected patient-, lesion- and procedure-related variables to identify correlates of mortality at 30 days.

Results We identified 155 patients (M = 107; mean age (SD) 64.3(11.4) years); 103 (66%) had STE at presentation. At 30d there were 97 survivors (mortality 37.4%). Variables associated with mortality were: cardiogenic shock at presentation (OR 3.34 [1.62, 6.89]), proximal LAD lesion (p = 0.004), final TIMI flow grade in the IRA (p = 0.012), age (p = 0.019), procedural failure (p = 0.01), residual stenosis in the culprit artery (p = 0.02), coexistent LMS stenosis (p = 0.02), and culprit artery bifurcation lesion (p = 0.03).

Conclusions In this preliminary analysis ST-segment elevation was absent in 1/3 of patients who had PCI-treatable lesions. Apart from age and cardiogenic shock there were no pre-procedural variables associated with 30-day survival. There should be a low threshold for offering mechanically-ventilated survivors of cardiac emergency access to the cath lab as outcomes are difficult to predict based on clinical features alone.

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