Download Primary ptca in resuscitated cardiac arrest complicating acute

Primary ptca in resuscitated cardiac arrest
complicating acute myocardial infarction.
Bertello F., Sicuro P., Casaccia M.,
Sbarra M., Conrotto P., Scacciatella F.
Turin, Italy.
Resuscitated Cardiac Arrest (CA) victims are an high risk subgroup of Acute Myocardial Infarction (AMI), that
could be excluded from lytic therapy, because of prolonged cardiopulmonary resuscitation and could evolve to
cardiogenic shock. Primary PTCA is potentially useful, but logistics and outcomes are poorly investigated. The
aim of the study was to evaluate feasibility and results of primary PTCA in this high risk subset of patients.
In a 24 months period 215 consecutive AMI patients, admitted in our Institution, underwent primary PTCA, 18
(8.4%) experienced in-hospital or out-of -hospital resuscitated CA.
Mean age was 60±13,6 years, male/female ratio was 2.6/1. CA occurred in an out-of-hospital setting in 38.9%
and in-hospital in 61.1% of patients. In all cases CA presenting rhythm was Ventricular Fibrillation. All patients
experienced Advanced Life Support, lasting 11±10 min (range 3 -30). 40% of patients came in Cardiac
Catheterisation Laboratory with an orotracheal tube and assisted ventilation. 44% of patients were in
cardiogenic shock. AMI was anterior in 50% of cases. Culprit coronary vessel was left anterior descending in
50%, right in 30%, circumflex in 20% of cases. Mean door-to -balloon time was 76.1±33.1 min. In all cases a
procedural success was obtained, with a TIMI 3 flow in 94%. Intraaortic counterpulsation was performed in
17% of patients. 30 day mortality was 5.5%, 71% of patients had a full neurological recovery, 16.6% minor
neurological damage, 11.1% maior neurological damage.
Primary PTCA in AMI patients with in-hospital or out-of-hospital resuscitated CA is feasible and shows similar
procedural results than not complicated AMI patients. Prognostic impact in this high risk subgroup seems to
be relevant, considering low mortality and high neurological recovery ratio.
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Updating: 09/12/2003