Abstract

Immediate coronary intervention in comatose survivors of out of hospital cardiac arrest: Outcomes from two tertiary, 24/7 primary percutaneous coronary intervention centres in UK

Author(s): Ahmed Hailan*, Rabeya Khatun, Adrian Ionescu, Owen Bodger, Tim Kinnaird, Mohammed Y Khanji

Background: There is a relative lack of data regarding the outcomes of comatose patients who present to the cath lab intubated and ventilated. Aim of the study: To analyse patient- and procedural-related variables at the time of emergency percutaneous coronary intervention (PCI) in patients who arrive in the cath lab intubated and ventilated and establish their relation to 30-day mortality. Setting: Two regional tertiary cardiac centres, the University Hospital of Wales in Cardiff and Morriston Cardiac Centre in Swansea. Methods: We included all consecutive patients between 01/03/2007 and 31/03/2014 who had PCI to a native coronary artery while being intubated and ventilated, and we documented their clinical and interventional features using the cath lab databases of the 2 institutions. We correlated these features with survival status at 30 days. Results: We included 133 patients (71% M), mean age 63.7 years (61.7-65.8; 95% confidence interval - CI) who had primary PCI for ST-segment elevation myocardial infarction (STEMI) (62%), PCI for unstable angina (UA)/ Non-STEMI (NSTEMI) (31%) or rescue PCI (8%). Mortality was 37% at 30 days, with most deaths occurring during the first week after PCI. The following features correlated with mortality (p values): History of myocardial infarction (MI) (0.026); age (0.021), cardiogenic shock (0.007), reduced pre-procedural Thrombolysis in myocardial infarction (TIMI) flow in the culprit artery (0.020), number of coronary arteries with stenosis >70% (0.03), incomplete revascularisation (0.01). In multi-variate analysis only cardiogenic shock (p=0.008; OR 4.552), incomplete revascularisation (p<0.001; OR 7.554) and