Out-of-hospital Cardiac Arrest (OOHCA) referred for Primary Percutaneous Coronary Intervention (PPCI): Results in a regional setting

Abstract

Background: The Sunshine Coast Hospital and Health Service (SCHHS) commenced a Primary Percutaneous Coronary Intervention (PPCI) service at Nambour General Hospital (NGH) in 2012. Out-of-hospital cardiac arrest (OOHA) secondary to ST elevation myocardial infarction (STEMI) has a guarded prognosis. Aim: We sought to study the characteristics and 30-day outcomes of patients with out-of-hospital arrest secondary to a STEMI whom were referred for PPCI. Methods and Results: Data was collected prospectively over a 2.2 year period. Of 427 PPCI activations during this time, 31 patients were referred following OOHA with ST elevation on ECG. The majority occurred after hours (71%) and most had Queensland Ambulance Service (QAS) pre-hospital activation of the catheterisation lab (65%). The majority were male (84%) at a mean age of 60.0yr+/-14.2yrs. There was a high prevalence of smokers (45%). Most arrived intubated (20/31, 65%) and use of inotropes high (11/31, 35%). The Median DTB was 64 minutes (IQR: 28-76 minutes). Most received PCI (84%) and only one received intra-aortic balloon pump (IABP). Culprit lesion was LMCA (3%); LAD (55%); RCA (19%); LCX (10%). No culprit identified in four patients (13%). The most common stent was DES (77%) vs BMS (23%) vs no PCI (10%). Thirty-day mortality was (6/31, 18%). Conclusion: Survivors of OOHA with STEMI referred for PPCI can achieve favourable 30-day survival in the setting of good door-to-balloon times.<br />