Urgent invasive coronary strategy in patients with sudden cardiac arrest

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Abstract

Purpose of review

To review the evidence on urgent coronary angiography and percutaneous coronary intervention after resuscitated cardiac arrest and during ongoing cardiocerebral resuscitation.

Recent findings

In almost 450 patients with acute ST-elevation myocardial infarction after reestablishment of spontaneous circulation, success rate of primary percutaneous coronary intervention was 89%. Survival rates in conscious patients after reestablishment of spontaneous circulation were comparable to patients without preceding cardiac arrest while in comatose patients, survival was 57% and survival with acceptable neurological outcome 38%. Nonrandomized trials in 106 comatose survivors of cardiac arrest indicate that urgent invasive coronary strategy can be safely combined with mild induced hypothermia. Percutaneous coronary intervention is also feasible in patients undergoing cardiocerebral resuscitation. In 34 reported patients, the success rate of percutaneous coronary intervention was 88% and survival to hospital discharge 41%.

Summary

Urgent coronary angiography and percutaneous coronary intervention should be attempted in conscious patients after reestablishment of spontaneous circulation similarly as in patients with acute coronary syndromes without preceding cardiac arrest. In comatose survivors, urgent coronary strategy is reasonable if acute ischemic cause is suspected and if there is realistic hope for neurological recovery that should be facilitated with mild induced hypothermia. Urgent coronary invasive strategy may be successful also during ongoing resuscitation in selected patients without advanced heart diseases and significant comorbidities.

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