473 Comparison of Survival and Neurologic Recovery Following Initiation of Therapeutic Hypothermia in Patients With STEMI and Patients Without STEMI

Abstract

Therapeutic hypothermia (TH) has proved to be neuroprotective and increase survival in comatose pts presenting after out-of-hospital cardiac arrest (OHCA). However, there is limited data on pts with STEMI treated with primary PCI and therapeutic hypothermia. We sought to compare clinical outcomes in pts presenting with STEMI and pts without STEMI who survived cardiac arrest and were treated with TH. Using the University of Ottawa Heart Institute return of spontaneous circulation (ROSC) database, we retrospectively identified, consecutive comatose pts presenting with OHCA between August 2010 and April 2012 who required TH. We compared pts with STEMI to pts without STEMI. The primary endpoint was defined as favorable neurological outcome at discharge, using discharge home from hospital as a surrogate; and secondary endpoint being hospital survival. We identified 68 OHCA pts treated with TH: 37 were STEMI and 31 were without STEMI. The demographics of the two cohorts are depicted in Table 1. All the STEMI pts underwent cardiac catheterization. The procedure was done within 24 hours in 35 of these pts (97%): primary PCI was performed in 31 (84%) and a pharmacoinvasive strategy was used in 4 (11%). The primary endpoint, the proportion of pts surviving to home discharge in the STEMI group was 54% and 48% in the group without STEMI, p=0.81. Hospital survival was 54% in the STEMI group as compared to 52% in the group without STEMI, p=1.00. The median length of hospitalization for STEMI pts was 9 (4-16) days versus 13 (5-21) days for pts without STEMI, p= 0.16.Tabled 1 In comparison to pts without STEMI, pts with STEMI treated with an invasive reperfusion strategy, appear to equally benefit from TH.