Long term prognostic impact of myocardium at risk and CTO presence in the setting of myocardial infarction complicated by out-of-hospital cardiac arrest

Abstract

No data exists, as to whether there is a correlation between the area at risk during a myocardial infarction (MI) complicated by OHCA and the survival rates. Moreover, there is no data concerning the prognostic role of the presence of a chronic total occlusion (CTO). We sought to estimate if 1) an angiographic score specifying the myocardium at risk during a myocardial infarction (MI) complicated by OHCA is predictive of the survival, 2) the presence of at least one CTO is associated with long-term prognosis in these patients. Retrospective single-centre study including patients aged ≥ 18 years resuscitated from an OHCA without evident noncardiac cause, with sustained return of spontaneous circulation (ROSC), undergoing on admission CA with PCI if indicated. A modified version of the angiographic score APPROACH (APPROACH M) already validated, has been used in order to estimate the myocardium at risk of necrosis. The survival was recorded until five years after the hospital discharge. A total of 300 comatose patients aged 56 years (IQR 48–67 years) were included. Thirty-six per cent presented ST-segment elevation. All had on-admission CA. Thirty-one per cent had acute coronary syndrome (ACS). PCI was attempted in 91% of ACS patients and was successful in 93%. Patients with coronary artery disease (CAD) had better 5-year survival (38.3%) compared with non-CAD patients (26.5%, P = 0.044). Among ACS patients ( n = 88), 5-year survival was better (45.5%, n = 25) when APPROACH M score ≤ 29.7 (median value) compared to patients with APPROACH M score > 29.7 (18.2%, n = 6, P < 0.001). Finally, as far as CTO is concerned, among 85 ACS patients post MI, 12 had at least one CTO, 4 survived (33%), while in 73 without CTO, 32 (43.9%) did so 5 five years after ( P = 0.495). The myocardium at risk during MI complicated by OHCA, estimated by APPROACH M score, seems to be associated with long-term survival. The presence of a CTO was not associated with survival.