Impact of Percutaneous Coronary Intervention Performance Reporting on Cardiac Resuscitation Centers

Abstract

Patients who experience out-of-hospital cardiac arrest (OHCA) have high mortality rates. Acute coronary occlusions and high-risk coronary obstructive disease are common in this population, especially in patients with ventricular tachycardia or ventricular fibrillation (VF) as the presenting cardiac arrest (CA) rhythm. In one recent series, 32% of patients with OHCA and sustained return of spontaneous circulation (ROSC) had ST-segment elevation on their first documented ECG.1 The vast majority of patients are unable to give a history of prearrest symptoms on hospital arrival because they are comatose. The “2010 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC)” state that “appropriate treatment of ACS or STEMI, including PCI, should be initiated regardless of coma (Class I, LOE B)” and “coma and the use of induced hypothermia are not contraindications or reasons to delay PCI.”2 The 2010 AHA Guidelines for CPR and ECC also state that “PCI after ROSC in subjects with arrest of presumed cardiac etiology may be reasonable, even in the absence of a clearly defined STEMI (Class IIb, LOE B).” Quality postarrest care was thought to make such a significant contribution to overall survival after CA that the AHA added a fifth link to the Chain of Survival to emphasize the importance of care after resuscitation treatments. The AHA recently issued a policy statement calling for the establishment of regional systems of care to manage OHCA patients.3 The proposed model is patterned after similar successful major trauma, ST-segment elevation myocardial infarction (STEMI), and stroke programs. The policy statement recommends a comprehensive, regionalized approach to postresuscitation care that includes therapeutic hypothermia, multidisciplinary goal-directed management of critical physiological functions (ie, organ perfusion, ventilation, metabolic management), and early coronary angiography/percutaneous coronary intervention (PCI) when indicated. The AHA policy statement defines 2 levels of cardiac …