Does time delay between the primary cardiac arrest and PCI affect outcome?

Objectives: In patients with acute ST-segment elevation acute myocardial infarction (AMI), no data are available on the prognostic value of cardiac arrest (CA) due to ventricular fibrillation (VF) before, during, and after percutaneous coronary intervention (PCI). The aim of our study was to determine differences in prognosis between patients with CA before, during, and after PCI.

Methods: Among 448 patients with first ST-segment elevation AMI, we selected 34 (7.6%) with primary CA due to VF and 6 (1.3%) with secondary CA. The patients with primary CA were categorized into groups according to the time of the first episode of the primary CA, either before [12 (35.3%)], during [18 (52.9%)], or after [4 (11.8%)] PCI procedure. The 30-day all-cause mortality rate was analysed.

Results: Short-term mortality was: (i) in patients without CA: 7.1% (29/408); (ii) in patients with primary CA 35.3% (12/34); (iii) in patients with secondary CA 50% (3/6); (P < 0.001). Mortality was 8.3% (1/12) in patients with primary CA before PCI; 44.4% (8/18) in patients with primary CA during PCI; 75% (3/4) in patients with primary CA after PCI procedure; (P = 0.007).

Conclusions: Patients with a primary CA have the same poor prognosis as patients with a secondary CA. The prognosis worsened according to the time of the occurrence of the primary CA. It might be reasonable to isolate subgroups of ST-segment elevation AMI patients treated with PCI with primary CA according to time of primary CA. This could help to better stratify the risk of these patients.