Little is known about the impact of early invasive treatment in patients following out-of-hospital cardiac arrest (OHCA). The present study investigated the clinical characteristics and long-term prognosis of 1254 patients with suspected acute coronary syndrome, including 65 with OHCA who underwent successful cardiopulmonary resuscitation (CPR) and 1189 patients who did not require CRP. All patients underwent immediate coronary angiography even if clear signs of myocardial infarction (MI) were absent. The incidence of ST-elevation and non-ST-elevation MI did not differ between the two groups. Cardiac biomarkers were significantly higher in CPR patients despite a shorter period from symptom onset to admission. The 6-month mortality rate was 29% in the CPR group and 4% in the non-CPR group, with > 90% of fatalities occurring ≤ 3 weeks after admission. In summary, early invasive treatment leads to a considerably reduced mortality and improved prognosis in patients after OHCA.
VoipioVKuismaMAlaspaaA: Thrombolytic treatment of acute myocardial infarction after out-of-hospital cardiac arrest. Resuscitation2001; 49: 251–258.
2.
GrubbNREltonRAFoxKA: In-hospital mortality after out-of-hospital cardiac arrest. Lancet1995; 346: 417–421.
3.
MyerburgRJ: Sudden cardiac death: exploring the limits of our knowledge. J Cardiovasc Electrophysiol2001; 12: 369–381.
4.
SpauldingCMJolyLMRosenbergA: Immediate coronary angiography in survivors of out-of-hospital cardiac arrest. N Engl J Med1997; 336: 1629–1633.
5.
DaviesMJThomasA: Thrombosis and acute coronary-artery lesions in sudden cardiac ischemic death. N Engl J Med1984; 310: 1137–1140.
6.
MyerburgRJKesslerKMEstesD: Long-term survival after prehospital cardiac arrest: analysis of outcome during an 8 year study. Circulation1984; 70: 538–546.
7.
StadlbauerKHKrismerACArntzHR: Effects of thrombolysis during out-of-hospital cardiopulmonary resuscitation. Am J Cardiol2006; 97: 305–308.
8.
KeeleyECGrinesCL: Should patients with acute myocardial infraction be transferred to a tertiary center for primary angioplasty or receive it at qualified hospitals in the community? The case for emergency transfer for primary percutaneous coronary intervention. Circulation2005; 112: 3520–3533.
9.
De LucaGSuryapranataHOttervangerJP: Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation2004; 109: 1223–1225.
10.
GarotPLefevreTEltchaninoffH: Six-month outcome of emergency percutaneous coronary intervention in resuscitated patients after cardiac arrest complicating ST-elevation myocardial infarction. Circulation2007; 115: 1354–1362.
11.
BendzBEritslandJNakstadAR: Long-term prognosis after out-of-hospital cardiac arrest and primary percutaneous coronary intervention. Resuscitation2004; 63: 49–53.
12.
DammanPHirschAWindhausenF: 5-year clinical outcomes in the ICTUS (Invasive versus Conservative Treatment in Unstable coronary Syndromes) trial: A randomized comparison of an early invasive versus selective invasive management in patients with non-ST-elevation acute coronary syndrome. J Am Coll Cardiol2010; 55: 858–864.
13.
AntmanEMCohenMBerninkPJ: The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making. JAMA2000; 284: 835–842.
14.
Hunt SA, American College of Cardiology, American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol2005; 46: e1–e82.
15.
BraunwaldE: Unstable angina. A classification. Circulation1989; 80: 410–414.
16.
LoombaRSAroraR: ST elevation myocardial infarction guidelines today: A systematic review exploring updated ACC/AHA STEMI guidelines and their applications. Am J Ther2009; 16: e7–e13.
17.
Van de WerfFBaxJBetriuA: Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J2008; 29: 2909–2945.
18.
NeumannFJKastratiAMurrayG Pogatsa: Evaluation of prolonged antithrombotic pretreatment (“cooling-off” strategy) before intervention in patients with unstable coronary syndromes: A randomized controlled trial. JAMA2003; 290: 1593–1599.
19.
HirschAWindhausenFTijssenJG: Long-term outcome after an early invasive versus selective invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome and elevated cardiac troponin T (the ICTUS trial): A follow-up study. Lancet2007; 369: 827–835.
20.
FoxKAAndersonFADabbousOH: Intervention in acute coronary syndromes: do patients undergo intervention on the basis of their risk characteristics? The Global Registry of Acute Coronary Events (GRACE). Heart2007; 93: 177–182.
21.
GiuglianoRPNewbyLKHarringtonRA: The early glycoprotein IIb/IIIa inhibition in non-ST-segment elevation acute coronary syndrome (EARLY ACS) trial: A randomized placebo-controlled trial evaluating the clinical benefits of early front-loaded eptifibatide in the treatment of patients with non-ST-segment elevation acute coronary syndrome—study design and rationale. Am Heart J2005; 149: 994–1002.
22.
MontalescotGCaylaGColletJP: Immediate vs delayed intervention for acute coronary syndromes: A randomized clinical trial. JAMA2009; 302: 947–954.
23.
Task Force for Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of European Society of Cardiology Bassand JP, Hamm CW, et al: Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. Eur Heart J2007; 28: 1598–1660.
24.
McCulloughPAPrakashRTobinKJ: Application of a cardiac arrest score in patients with sudden death and ST segment elevation for triage to angiography and intervention. J Interv Cardiol2002; 15: 257–261.
HerlitzJBangAGunnarssonJ: Factors associated with survival to hospital discharge among patients hospitalised alive after out of hospital cardiac arrest: change in outcome over 20 years in the community of Göteborg, Sweden. Heart2003; 89: 25–30.
27.
ReynoldsJCCallawayCWEl KhoudarySR: Coronary angiography predicts improved outcome following cardiac arrest: propensity-adjusted analysis. J Intensive Care Med2009; 24: 179–186.
28.
LinssenGCBakkerSJVoorsAA: N-terminal pro-B-type natriuretic peptide is an independent predictor of cardiovascular morbidity and mortality in the general population. Eur Heart J2010; 31: 120–127.
29.
WeberMDillTArnoldR: N-terminal B-type natriuretic peptide predicts extent of coronary artery disease and ischemia in patients with stable angina pectoris. Am Heart J2004; 148: 612–620.
