Coronary angioplasty improves cardiac arrest survival

October 20, 2012 in Cardiology

Coronary angioplasty improves survival in all patients with out of hospital cardiac arrest, according to research presented at the Acute Cardiac Care Congress 2012. The study was presented by Dr Annamaria Nicolino from the Santa Corona General Hospital in Pietra Ligure, Italy.

The Acute Congress 2012 is the first annual meeting of the newly launched Acute Association (ACCA) of the European Society of Cardiology (ESC). It takes place during 20-22 October in Istanbul, Turkey, at the Istanbul Lufti Kirdar Convention and Exhibition Centre (ICEC).

Out of hospital is a leading cause of mortality and acute is the leading cause of cardiac arrest. It is well known that when an electrocardiogram (ECG) shows that a patient has ST elevation, primary angiography must be done as soon as possible. If severe coronary disease is found, with percutaneous (PCI) is performed to open the blocked vessel.

But Dr Nicolino said: "There is controversy about what to do when a patient with out of hospital cardiac arrest has a normal ECG that does not show ST elevation. ESC Clinical Practice Guidelines are inconclusive – they say to consider performing coronary angiography but they don't say 'do it' or 'don't do it'."

She added: "Some previous studies have found that if the ECG is normal (no ST elevation) the patient can still have severe coronary disease and therefore needs a coronary angiography, followed by coronary angioplasty, to clear the blocked vessel."

The current study aimed to discover whether performing urgent coronary angiography, and PCI if required, would improve survival in all with out of hospital cardiac arrest (both those with ST elevation and those without).

The study included 70 patients who had out of hospital cardiac arrest between 2006 and 2009. Successful urgent coronary angiography and PCI improved hospital survival in all patients with . The treatment increased hospital survival rates in patients with ST elevation myocardial infarction (STEMI) from 51% to 83% (p=0.003) and in non-STEMI (NSTEMI) patients from 55% to 81% (p=0.004).

"In our study, a successful urgent coronary angioplasty improved hospital survival in patients with STEMI and NSTEMI," said Dr Nicolino. "All patients with out of hospital cardiac arrest, if there is no non-cardiac cause, must have an urgent coronary angiography followed by coronary angioplasty if there is coronary disease."

Non-cardiac causes of cardiac arrest which should be ruled out before performing coronary angiography are trauma, brain haemorrhage and metabolic problems such as severe hypoglycaemia.

Dr Nicolino added: "ECG results can be misleading – we found that ECG detected just one-third of acute coronary syndrome in NSTEMI patients. This means that even if the ECG is not showing ST elevation, you cannot rule out an acute coronary syndrome. Coronary angiography should be performed urgently to see if there is any acute which needs treatment with PCI."

Post-resuscitation neurologic injury (PNI) was the biggest complication. This can occur if resuscitation is not performed early enough, since the brain's blood supply stops during cardiac arrest. The 32.8% of patients who had PNI were at the greatest risk of death. Early signs of PNI were associated with underuse of coronary angioplasty and PCI.

Provided there was no neurological injury, MI patients who had angioplasty after cardiac arrest achieved the same one-year survival rates as patients with MI alone.

The first heart rhythm was a ventricular fibrillation (VF) or a ventricular tachycardia (VT) in 62% of patients. Most of these patients had an acute coronary syndrome (STEMI or NSTEMI). The incidence of VF and VT was the same in STEMI and NSTEMI patients. "For many years we have thought that patients with STEMI have a greater arrhythmic risk than NSTEMI patients," said Dr Nicolino. "But we found that both STEMI and NSTEMI patients are at high risk of arrhythmias."

She added: "If the first recorded rhythm is a VF or a VT an acute coronary syndrome is highly probable and it's important to perform a immediately without waiting for a diagnosis of infarction (using an enzyme test)."

Dr Nicolino concluded: "Patients with out of hospital cardiac arrest must be managed by cardiologists, intensive care doctors and anaesthesiologists. This team can save the brain from injury using cooling therapy, and save the heart and life of the patient using coronary angioplasty."

Provided by European Society of Cardiology search and more info website

5 /5 (2 votes)  

Rank 5 /5 (2 votes)
Relevant PhysicsForums posts
  • Magnetic field and repulsion bewteen wires
    created1 hour ago
  • Enthalpy of reaction
    created7 hours ago
  • Harmonic oscillation problem -Dancing pot
    created8 hours ago
  • Ultracapacitor to power electromagnet?
    created9 hours ago
  • Confusion in Electro Statics
    created9 hours ago
  • simple gravity question
    created10 hours ago
  • More from Physics Forums - Classical Physics

More news stories

Hospitals' cardiac arrest incidence and survival rates go hand in hand

Hospitals with the highest rates of cardiac arrests tend to have the poorest survival rates for those cases, new University of Michigan Health System research shows.

Cardiology created 26 minutes ago | popularity not rated yet | comments 0

Effect of fluid and sodium restrictions on weight loss among patients with heart failure

A clinical trial of 75 patients hospitalized with acute decompensated heart failure (ADHF) suggests that aggressive fluid and sodium restriction has no effect on weight loss or clinical stability at three days but was associated ...

Cardiology created 26 minutes ago | popularity not rated yet | comments 0

Which women should be screened for high cholesterol?

National guidelines recommend that at-risk women be screened for elevated cholesterol levels to reduce their chances of developing cardiovascular disease. But who is 'at risk?' The results of a study by investigators ...

Cardiology created 3 hours ago | popularity not rated yet | comments 0

Atherosclerotic disease heredity mapped in nationwide study

Researchers at Lund University in Sweden have mapped the significance of heredity for common forms of atherosclerotic disease. No studies have previously examined whether different forms of the disease share heredity.

Cardiology created 5 hours ago | popularity not rated yet | comments 0

Study finds improved CPR quality saves lives

(Medical Xpress)—Life-saving CPR has been a foundation of emergency medicine for more than a half century. But researchers at the University of Arizona College of Medicine-Phoenix are continuing to refine the procedure, ...

Cardiology created 6 hours ago | popularity not rated yet | comments 0


The compound in the Mediterranean diet that makes cancer cells 'mortal'

New research suggests that a compound abundant in the Mediterranean diet takes away cancer cells' "superpower" to escape death. By altering a very specific step in gene regulation, this compound essentially re-educates cancer ...

Study shows how bilinguals switch between languages

(Medical Xpress)—Individuals who learn two languages at an early age seem to switch back and forth between separate "sound systems" for each language, according to new research conducted at the University of Arizona.

Study suggests new source of kidneys for transplant

Nearly 20 percent of kidneys that are recovered from deceased donors in the U.S. are refused for transplant due to factors ranging from scarring in small blood vessels of the kidney's filtering units to the organ going too ...

Discovery of circadian clock in mice hair reveals period of time when damage from radiotherapy can be quickly repaired

Discovering that mouse hair has a circadian clock - a 24-hour cycle of growth followed by restorative repair - researchers suspect that hair loss in humans from toxic cancer radiotherapy and chemotherapy ...

SARS-like virus claims new life in Saudi

A Saudi man who had contracted the coronavirus has died, raising the death toll in the kingdom from the SARS-like virus to 16, the health ministry announced on Monday on its Internet website.

Gym class reduces probability of obesity, study finds for first time

Little is known about the effect of physical education (PE) on child weight, but a new study from Cornell University finds that increasing the amount of time that elementary schoolchildren spent in gym class reduces the probability ...