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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