Abstract 10360: Prognostic Impact of Early Revascularization in Patients With Cardiac Arrest Due to Acute Coronary Syndrome Undergoing Extracorporeal Cardiopulmonary Resuscitation

Abstract

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) and emergency revascularization has been reported to improve survival in patients with refractory cardiac arrest complicated by acute coronary syndrome (ACS). However the best timing for this therapy is not clear. We investigated the relationship between the time interval from collapse to revascularization and mortality for ECPR in the patients with non-ST and ST elevation ACS. Methods: A cohort of 228 patients who underwent ECPR at our hospital was registered from January 2005 to April 2015. After excluding 121 patients with non-ACS, we analyzed the clinical outcome which was defined as all-cause death at 30 days of the remaining 107 patients (63±11years old, 90% male). We divided patients into 3 groups according to collapse to revascularization time; Group1 (time<90min: n=28), Group2 (90≦time<180min: n=40) and Goup3 (time≧180min or unsuccessful of revascularization: n=39). Results: 43 patients was non-ST elevation ACS. 81 patients underwent emergency revascularization. 29 patients had 30 days survival. Platelet and bicarbonate ion was higher in Group1. Lactate level was lower in Group1. But other baseline characteristics did not differ. Kaplan-Meier curve showed Group1 was better outcome compared with other groups (p<0.0001 log-rank) (Figure). Multivariate analysis revealed that independent predictors of 30 days in-hospital mortality were longer time interval from collapse to revascularization (per increase OR: 1.05, 95%CI:1.01-1.08, p<0.01), lactate level (OR:0.42 , 95%CI:0.22-0.83, p=0.01) and other factors. Incidence of all-cause death at 30 days was significantly higher both ST and non-ST elevation ACS in Group3 than in Group 1 and 2; (ST elevation in Group3 vs 2 and 1: 84% vs 58%; p<0.05) (non-ST: 100% vs 70% ;p<0.01). Conclusions: Shorter time interval from collapse to revascularization predict better clinical outcome in patients with non-ST and ST elevation ACS undergoing ECPR.