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Primary percutaneous coronary intervention is currently known as the most effective reperfusion strategy in patients with ST-elevation myocardial infarction. There are no formal recommendations from the American Heart Association/American College of Cardiology and European Society of Cardiology guidelines regarding the treatment of comatose patients with signs of ST-elevation myocardial infarction after reestablishment of spontaneous circulation.We assessed prognosis in 31 consecutive comatose ST-elevation myocardial infarction patients admitted to our intensive cardiac care unit after early percutaneous coronary intervention from 1 January 2005 to 30 June 2006.During intensive cardiac care unit stay, eight patients died (8/23, 34.7%). In comparison between patients who died and those who survived, the former were older (P = 0.049), showed a higher incidence of chronic obstructive pulmonary disease and had a shorter intensive cardiac care unit length of stay (P = 0.001). No differences were detectable in the two subgroups regarding angiographic characteristics. The incidence of thrombolysis in myocardial infarction grade 3 postpercutaneous coronary intervention was higher in patients who survived (P = 0.0437). Patients who died showed higher latency times, both symptoms-to-basic life support and symptoms-emergency-team (P = 0.0171 and 0.0116, respectively). Patients who survived showed a higher ejection fraction than those who died, as well as lower values of peak troponin I, leukocytes and glycemia (P = 0.01, 0.001 and 0.05, respectively).According to our data, comatose survivors undoubtedly present a high-risk subgroup of ST-elevation myocardial infarction population in which percutaneous coronary intervention shows a procedural efficacy similar to conscious ST-elevation myocardial infarction patients and whose prognosis seems to be related both to infarct size and to neurological status. Further studies need to be performed in this high-risk subgroup investigating the effects of mild hypothermia (mainly on the neurological outcome) as well as the feasibility, safety and outcome of assistance device.