Mild therapeutic hypothermia after out-of-hospital cardiac arrest complicating ST-elevation myocardial infarction: long-term results in clinical practice
| Autor: | Stefan, Zimmermann, Frank A, Flachskampf, Reinhard, Schneider, Katharina, Dechant, Anna, Alff, Lutz, Klinghammer, Harald, Rittger, Stephan, Achenbach |
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| Rok vydání: | 2013 |
| Předmět: |
Male
Neurologic Examination Time Factors fungi Myocardial Infarction Clinical Investigations Recovery of Function Middle Aged Coronary Angiography Nervous System Time-to-Treatment Logistic Models Percutaneous Coronary Intervention Treatment Outcome Hypothermia Induced Risk Factors Multivariate Analysis Odds Ratio Humans Female Stents Out-of-Hospital Cardiac Arrest Platelet Aggregation Inhibitors Aged Retrospective Studies |
| Zdroj: | Clinical cardiology. 36(7) |
| ISSN: | 1932-8737 |
| Popis: | BACKGROUND: Recently, mild therapeutic hypothermia (MTH) has been integrated into the European resuscitation guidelines to improve outcomes after out‐of‐hospital cardiac arrest (OHCA). Data on long‐term results are limited, especially in patients with acute ST‐elevation myocardial infarction (STEMI). HYPOTHESIS: Invasive MTH influences long‐term prognosis after OHCA due to STEMI. METHODS: We analyzed 48 patients who underwent emergency coronary angiography for STEMI after witnessed OHCA. In 24 consecutive patients, MTH was performed via intravascular cooling (CoolGard System, 34°C maintained for 24 hours) after initialization by rapid infusion of cold saline. Clinical, procedural, and mortality data were compared to 24 historical controls. Neurological recovery was assessed using the Cerebral Performance Category score (CPC) at 30‐day and 1‐year follow‐up. RESULTS: Median time delay until arrival of emergency medical service was 6 minutes (MTH group) vs 6.5 minutes (controls) (P = 0.16). Initial rhythm was ventricular fibrillation in 75% vs 66.7% (P = 0.75). There were no differences regarding baseline characteristics, angiographic findings, and success of cardiac catheterization procedures. MTH was not associated with a higher frequency of bleeding complications or of pneumonia. Thirty‐day mortality was 33.3% in both groups. One‐year mortality was 37.5% (MTH group) vs 50% (controls) (P = 0.56). At 1 year, favorable neurological outcome (CPC ≤2) was significantly more frequent in the MTH group (58.3% vs 20.8%, P = 0.017). Multivariate analysis identified MTH as independent predictor of favorable neurological outcome (P |
| Databáze: | OpenAIRE |
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