Abstract 26: Impact of Total Occlusion of the Coronary Artery and the Amount of Infarct-Related Myocardium in Patients with Refractory Cardiac Arrest due to Acute Coronary Syndrome

Abstract

Introduction: Acute coronary syndrome (ACS) is a leading cause of sudden cardiac arrest. Percutaneous coronary intervention (PCI) may provide improved outcomes for resuscitated patients; however, prognosis in refractory cardiac arrest patients remains poor. Hypothesis: We assessed the hypothesis that total occlusion of the culprit coronary artery is associated with refractory cardiac arrest that is unresponsive to conventional cardiopulmonary resuscitation (CPR). Methods: Adult out-of-hospital cardiac arrest patients who underwent emergency coronary angiography and were diagnosed with ACS were enrolled in this retrospective study. We divided the patients into 2 groups: patients who achieved return of spontaneous circulation by conventional CPR (group 1) and patients with refractory cardiac arrest who were unresponsive to conventional CPR and were treated with extracorporeal CPR (group 2). Data about thrombolysis in myocardial infarction flow grade were collected at initial coronary angiography. P < 0.05 was defined as statistically significant. Results: We enrolled 54 patients (group 1; n = 35), median age of the patients was 61 y (interquartile range 54-72 y), 87% patients were male, 81% patients were witnessed cardiac arrest, 57% patients were received CPR initiated by by-standers, and 67% patients showed shockable initial recorded rhythm. The rate of culprit lesion in the left main trunk was higher in group 2 than in group 1 (3% vs. 21%, P = 0.04), and that in the left circumflex artery was lower in group 2 (20% vs. 0%, P = 0.04). Thrombolysis in myocardial infarction flow grade 3 was observed in 29% of group 1 and 16% of group 2 patients (P = 0.34), and thrombolysis in myocardial infarction flow grade 0 or 1 was observed in 57% of group 1 and 84% of group 2 patients (P = 0.04). Coronary reperfusion therapy by PCI was performed in 81% of the patients, and all of whom achieved return of spontaneous heart-beat. Conclusions: Total occlusion of the coronary artery and a large amount of infarct related myocardium may be associated with refractory cardiac arrest due to ACS. Coronary reperfusion therapy could achieve higher rate of return of spontaneous heart-beat and may improve outcomes in patients with refractory cardiac arrest.