Primary percutaneous coronary intervention in comatose survivors of cardiac arrest with ST-elevation acute myocardial infarction: a single-center experience in Florence

J Cardiovasc Med (Hagerstown). 2008 Nov;9(11):1083-7. doi: 10.2459/JCM.0b013e3282ff82d4.


Objective: Primary percutaneous coronary intervention is currently known as the most effective reperfusion strategy in patients with ST-elevation myocardial infarction. There are no formal recommendations from the American Heart Association/American College of Cardiology and European Society of Cardiology guidelines regarding the treatment of comatose patients with signs of ST-elevation myocardial infarction after reestablishment of spontaneous circulation.

Methods: We assessed prognosis in 31 consecutive comatose ST-elevation myocardial infarction patients admitted to our intensive cardiac care unit after early percutaneous coronary intervention from 1 January 2005 to 30 June 2006.

Results: During intensive cardiac care unit stay, eight patients died (8/23, 34.7%). In comparison between patients who died and those who survived, the former were older (P = 0.049), showed a higher incidence of chronic obstructive pulmonary disease and had a shorter intensive cardiac care unit length of stay (P = 0.001). No differences were detectable in the two subgroups regarding angiographic characteristics. The incidence of thrombolysis in myocardial infarction grade 3 postpercutaneous coronary intervention was higher in patients who survived (P = 0.0437). Patients who died showed higher latency times, both symptoms-to-basic life support and symptoms-emergency-team (P = 0.0171 and 0.0116, respectively). Patients who survived showed a higher ejection fraction than those who died, as well as lower values of peak troponin I, leukocytes and glycemia (P = 0.01, 0.001 and 0.05, respectively).

Conclusion: According to our data, comatose survivors undoubtedly present a high-risk subgroup of ST-elevation myocardial infarction population in which percutaneous coronary intervention shows a procedural efficacy similar to conscious ST-elevation myocardial infarction patients and whose prognosis seems to be related both to infarct size and to neurological status. Further studies need to be performed in this high-risk subgroup investigating the effects of mild hypothermia (mainly on the neurological outcome) as well as the feasibility, safety and outcome of assistance device.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angioplasty, Balloon, Coronary* / adverse effects
  • Angioplasty, Balloon, Coronary* / mortality
  • Cardiopulmonary Resuscitation*
  • Coma / complications
  • Coma / mortality
  • Coma / therapy*
  • Female
  • Heart Arrest / complications
  • Heart Arrest / mortality
  • Heart Arrest / therapy*
  • Humans
  • Intensive Care Units
  • Italy
  • Male
  • Middle Aged
  • Myocardial Infarction / complications
  • Myocardial Infarction / mortality
  • Myocardial Infarction / therapy*
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome