Percutaneous Coronary Intervention After Return of Spontaneous Circulation Reduces the In-Hospital Mortality in Patients with Acute Myocardial Infarction Complicated by Cardiac Arrest

Jingcong Zhang,1,&ast; Haixia Xiong,2,&ast; Jie Chen,3 Qiuping Zou,4 Xiaoxing Liao,5 Yujie Li,6 Chunlin Hu6 1Department of Critical Care Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, People’s Republic of China; 2Department of Division of Nephrology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, People’s Republic of China; 3Department of Critical Care Medicine, the Dongguan People’s Hospital, Dongguan, Province Guangdong, 523059, People’s Republic of China; 4Department of Emergency Medicine the Dongguan People’s Hospital, Dongguan, Province Guangdong, 523059, People’s Republic of China; 5Department of Emergency Medicine, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518107, People’s Republic of China; 6Department of Emergency Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Chunlin Hu; Yujie LiDepartment of Emergency Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Province Guangdong, People’s Republic of ChinaEmail huchunl@mail.sysu.edu.cn; yujieligd@163.comBackground and Objective: The role of percutaneous coronary intervention (PCI) after return of spontaneous circulation (ROSC) in patients with acute myocardial infarction (AMI) complicated by cardiac arrest (CA) is controversial. This study aimed to evaluate the effects of PCI on the in-hospital mortality after ROSC in patients with AMI complicated by CA.Methods: The clinical data of 66 consecutive patients with ROSC after CA caused by AMI from January 2006 to December 2015 at the First Affiliated Hospital of Sun Yat-sen University were collected. Among these patients, 21 underwent urgent PCI. We analyzed the clinical characteristics of the patients during hospitalization.Results: The patients who underwent PCI had a higher rate of ST-segment elevation, and their initial recorded heart rhythms were more likely to have a shockable rhythm. Further, they had a high PCI success rate of 100%. The in-hospital mortality in the patients who did not undergo PCI was significantly higher than that in the patients who underwent PCI (68.9% vs 9.5%, P< 0.05). Multivariate logistic regression analysis showed that cardiogenic shock (odds ratio [OR], 3.537; 95% CI, 1.047– 11.945; P=0.042) and Glasgow Coma Scale score of ≤ 8 after ROSC (OR, 14.992; 95% CI, 2.815– 79.843; P=0.002) were the independent risk factors for in-hospital mortality among the patients. Meanwhile, PCI was a protective factor against in-hospital mortality (OR, 0.063; 95% CI, 0.012– 0.318; P=0.001). After propensity matching analysis, the results still showed that PCI (OR, 0.226; 95% CI, 0.028– 1.814; P=0.0162) was a protective factor for in-hospital death.Conclusion: The patients with ROSC after CA caused by AMI who underwent PCI had a lower in-hospital mortality than those who did not undergo PCI.Keywords: percutaneous coronary intervention, cardiac arrest, in-hospital mortality, neurological performance