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CLINICAL RESEARCH: ACUTE MYOCARDIAL INFARCTION

Survival and Neurologic Recovery in Patients With ST-Segment Elevation Myocardial Infarction Resuscitated From Cardiac Arrest

Vinay R. Hosmane, MD, MPH^_*, Nowwar G. Mustafa, MD^_*, Vivek K. Reddy, MD, Charles L. Reese, IV, MD, Angela DiSabatino, RN, MSN^_*, Paul Kolm, PhD, James T. Hopkins, MD, FACC^_*, William S. Weintraub, MD, FACC^_* and Ehsanur Rahman, MD, FACC^_*,_*

^_* Department of Medicine/Cardiology, Christiana Care Health System, Newark, Delware
Department of Medicine/Internal Medicine, Christiana Care Health System, Newark, Delware
Department of Emergency Medicine, Christiana Care Health System, Newark, Delware
Department of Christiana Care Outcomes Research Center, Christiana Care Health System, Newark, Delware

Manuscript received April 18, 2008; revised manuscript received August 27, 2008, accepted August 30, 2008.

^_* Reprint requests and correspondence: Dr. Ehsanur Rahman, Christiana Care Health System, Suite 2E99, 4755 Ogletown-Stanton Road, Newark, Delaware 19718 (Email: erahman{at}christianacare.org).

Objectives: We examined outcomes of patients resuscitated from cardiac arrest owing to ST-segment elevation myocardial infarction (STEMI) and predictors of survival and neurologic recovery.

Background: Immediately after resuscitation from cardiac arrest owing to STEMI, many patients show signs of neurologic impairment, and benefits of percutaneous coronary intervention and subsequent prognosis are not well defined.

Methods: Between January 1, 2002, and December 31, 2006, we retrospectively identified consecutive patients resuscitated from cardiac arrest, regardless of time to return of spontaneous circulation (ROSC) and neurologic status, and reviewed the outcomes of those who had STEMI. Mortality and neurologic recovery at discharge and long-term mortality were assessed by individual chart review for those who underwent emergent angiography.

Results: Our study population consisted of 98 patients; 64% survived to discharge, and 92% had a full neurologic recovery. Predictors of survival were shorter time to ROSC, younger age, neurologic status post-resuscitation (alert or minimally responsive), and male sex. Predictors of neurologic recovery included shorter time to ROSC, neurologic status post-resuscitation (alert or minimally responsive), and younger age. Ninety-six percent of patients who were alert post-resuscitation survived. Ninety-three percent of patients who were minimally responsive post-resuscitation survived. Fifty-nine patients were unresponsive post-resuscitation, with 44% survival, of whom 88% had full neurologic recovery. In the unresponsive group, unwitnessed arrest, prolonged ROSC, and older age were associated with increased risk of death, and older age and prolonged ROSC predicted poor neurologic recovery.

Conclusions: When resuscitated patients with STEMI are being evaluated in the emergency department, serious consideration should be given to emergent angiography and revascularization, regardless of neurologic status.

Key Words: cardiac arrest • STEMI • PCI

Abbreviations and Acronyms   CABG = coronary artery bypass graft   CPR = cardiopulmonary resuscitation   DTBT = door-to-balloon time   ECG = electrocardiograph   ED = emergency department   PCI = percutaneous coronary intervention   ROSC = return of spontaneous circulation   STEMI = ST-segment elevation myocardial infarction

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