Nav: Home

Coronary angioplasty improves cardiac arrest survival

October 19, 2012

Istanbul, Turkey - 20 October 2012: Coronary angioplasty improves survival in all patients with out of hospital cardiac arrest, according to research presented at the Acute Cardiac Care Congress 2012. The study was presented by Dr Annamaria Nicolino from the Santa Corona General Hospital in Pietra Ligure, Italy.

The Acute Cardiac Care Congress 2012 is the first annual meeting of the newly launched Acute Cardiovascular Care Association (ACCA) of the European Society of Cardiology (ESC). It takes place during 20-22 October in Istanbul, Turkey, at the Istanbul Lufti Kirdar Convention and Exhibition Centre (ICEC).

Out of hospital cardiac arrest is a leading cause of mortality and acute coronary occlusion is the leading cause of cardiac arrest. It is well known that when an electrocardiogram (ECG) shows that a patient has ST elevation, primary angiography must be done as soon as possible. If severe coronary disease is found, coronary angioplasty with percutaneous coronary intervention (PCI) is performed to open the blocked vessel.

But Dr Nicolino said: "There is controversy about what to do when a patient with out of hospital cardiac arrest has a normal ECG that does not show ST elevation. ESC Clinical Practice Guidelines are inconclusive - they say to consider performing coronary angiography but they don't say 'do it' or 'don't do it'."

She added: "Some previous studies have found that if the ECG is normal (no ST elevation) the patient can still have severe coronary disease and therefore needs a coronary angiography, followed by coronary angioplasty, to clear the blocked vessel."

The current study aimed to discover whether performing urgent coronary angiography, and PCI if required, would improve survival in all patients with out of hospital cardiac arrest (both those with ST elevation and those without).

The study included 70 patients who had out of hospital cardiac arrest between 2006 and 2009. Successful urgent coronary angiography and PCI improved hospital survival in all patients with acute coronary syndrome. The treatment increased hospital survival rates in patients with ST elevation myocardial infarction (STEMI) from 51% to 83% (p=0.003) and in non-STEMI (NSTEMI) patients from 55% to 81% (p=0.004).

"In our study, a successful urgent coronary angioplasty improved hospital survival in patients with STEMI and NSTEMI," said Dr Nicolino. "All patients with out of hospital cardiac arrest, if there is no non-cardiac cause, must have an urgent coronary angiography followed by coronary angioplasty if there is coronary disease."

Non-cardiac causes of cardiac arrest which should be ruled out before performing coronary angiography are trauma, brain haemorrhage and metabolic problems such as severe hypoglycaemia.

Dr Nicolino added: "ECG results can be misleading - we found that ECG detected just one-third of acute coronary syndrome in NSTEMI patients. This means that even if the ECG is not showing ST elevation, you cannot rule out an acute coronary syndrome. Coronary angiography should be performed urgently to see if there is any acute coronary disease which needs treatment with PCI."

Post-resuscitation neurologic injury (PNI) was the biggest complication. This can occur if resuscitation is not performed early enough, since the brain's blood supply stops during cardiac arrest. The 32.8% of patients who had PNI were at the greatest risk of death. Early signs of PNI were associated with underuse of coronary angioplasty and PCI.

Provided there was no neurological injury, MI patients who had angioplasty after cardiac arrest achieved the same one-year survival rates as patients with MI alone.

The first heart rhythm was a ventricular fibrillation (VF) or a ventricular tachycardia (VT) in 62% of patients. Most of these patients had an acute coronary syndrome (STEMI or NSTEMI). The incidence of VF and VT was the same in STEMI and NSTEMI patients. "For many years we have thought that patients with STEMI have a greater arrhythmic risk than NSTEMI patients," said Dr Nicolino. "But we found that both STEMI and NSTEMI patients are at high risk of arrhythmias."

She added: "If the first recorded rhythm is a VF or a VT an acute coronary syndrome is highly probable and it's important to perform a coronary angiography immediately without waiting for a diagnosis of infarction (using an enzyme test)."

Dr Nicolino concluded: "Patients with out of hospital cardiac arrest must be managed by cardiologists, intensive care doctors and anaesthesiologists. This team can save the brain from injury using cooling therapy, and save the heart and life of the patient using coronary angioplasty."
-end-


European Society of Cardiology

Related Cardiac Arrest Articles:

Smartphone app directs first responders to cardiac arrest three minutes before ambulance
A novel smartphone application (app) has been developed that can direct first responders to cardiac arrest victims more than three minutes before the emergency services arrive.
Cardiac arrest on plane journeys: New guidelines proposed
New guidelines to deal with the in-flight emergency of cardiac arrest in a passenger or crew member are being proposed at this year's Euroanaesthesia meeting in Geneva (June 3-5).
Cardiac arrest patients do better if taken immediately to a specialist heart center
People who suffer cardiac arrest outside of hospital have a better chance of survival if they are taken immediately to a specialist heart center rather than to the nearest general hospital, according to research published in the European Heart Journal.
'Harmless' painkillers associated with increased risk of cardiac arrest
Painkillers considered harmless by the general public are associated with increased risk of cardiac arrest, according to research published today in the March issue of European Heart Journal - Cardiovascular Pharmacotherapy.
Two treatments yield similar outcomes in children after in-hospital cardiac arrest
Body cooling vs. active fever prevention: Emergency body cooling does not improve survival or functional outcomes in children who experience in-hospital cardiac arrest any more than normal temperature control.
Use of statins before cardiac arrest may aid survival afterwards
Patients who have been using cholesterol-lowering drugs known as statins fare better after a cardiac arrest than non-users.
CPR from bystanders associated with better outcomes after out-of-hospital cardiac arrest in pediatrics
Receiving cardiopulmonary resuscitation from a bystander -- compared with not -- was associated with better overall and neurologically favorable survival for children and adolescents who had out-of-hospital cardiac arrest, according to an article published online by JAMA Pediatrics.
AED accessibility a barrier during cardiac arrest
There's just a 1 in 5 chance that a potentially life-saving automated external defibrillator will be nearby when someone experiences cardiac arrest and a 20 to 30 percent chance that the nearby device will be inaccessible because it is inside a building that's closed, according to a study published today in the Journal of the American College of Cardiology.
Are we giving up on cardiac arrest patients too soon?
A University of Arizona study suggests physicians need to give comatose cardiac arrest survivors adequate time before predicting outcomes.
Gender gap found in cardiac arrest care, outcomes
Women treated at a hospital after cardiac arrest may be less likely than men to receive potentially life-saving procedures.

Related Cardiac Arrest Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Climate Crisis
There's no greater threat to humanity than climate change. What can we do to stop the worst consequences? This hour, TED speakers explore how we can save our planet and whether we can do it in time. Guests include climate activist Greta Thunberg, chemical engineer Jennifer Wilcox, research scientist Sean Davis, food innovator Bruce Friedrich, and psychologist Per Espen Stoknes.
Now Playing: Science for the People

#527 Honey I CRISPR'd the Kids
This week we're coming to you from Awesome Con in Washington, D.C. There, host Bethany Brookshire led a panel of three amazing guests to talk about the promise and perils of CRISPR, and what happens now that CRISPR babies have (maybe?) been born. Featuring science writer Tina Saey, molecular biologist Anne Simon, and bioethicist Alan Regenberg. A Nobel Prize winner argues banning CRISPR babies won’t work Geneticists push for a 5-year global ban on gene-edited babies A CRISPR spin-off causes unintended typos in DNA News of the first gene-edited babies ignited a firestorm The researcher who created CRISPR twins defends...