32 Outcomes of PCI in mechanically-ventilated survivors of cardiac arrest: the view from wales. (24th April 2016)

• Record Type: Journal Article
• Authors: Hailan, A; Khatun, R; Khanji, M; Battle, C; Temblett, P; Bodger, O; Kinnaird, T; Ionescu, A
• Is Part Of: Heart. Volume 102(2016)Supplement 4
• Page Start: A14
• Page End: A14
• Publication Date: 2016-04-24
• Subjects: Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2016-309588.32
• Languages: English
• ISSNs: 1355-6037

Abstract

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.