Table 3.
Baseline characteristics of patients after out-of-hospital cardiac arrest due to acute myocardial infarction undergoing mild therapeutic hypothermia.
| STEMI (n = 11) | NSTEMI (n = 10) | P | |
|---|---|---|---|
| Demographic data | |||
| Males | 9 (82%) | 8 (80%) | 0.9 |
| Age | 65 ± 9 | 68 ± 13 | 0.5 |
| History of myocardial infarction | 0 | 1 (10%) | 0.3 |
| History of ischemic heart disease | 1 (9%) | 2 (20%) | 0.5 |
| Arterial hypertension | 7 (64%) | 7 (70%) | 0.8 |
| Diabetes mellitus type 2 | 2 (18%) | 4 (40%) | 0.3 |
| Dyslipidemia | 4 (36%) | 5 (50%) | 0.5 |
| Obesity | 4 (36%) | 4 (40%) | 0.9 |
| Tobacco smoking | 4 (36%) | 2 (20%) | 0.4 |
| Revascularization | 0 | 2 (20%) | 0.1 |
| Chronic kidney disease stage 5 | 0 | 1 (10%) | 0.5 |
| Atrial fibrillation | 0 | 2 (20%) | 0.1 |
| Arrest data | |||
| Initial cardiac arrest rhythm: | |||
| VF/VT | 10 (91%) | 7 (70%) | 0.2 |
| Asystole | 0 | 2 (20%) | 0.1 |
| Pulseless electrical activity | 1 (9%) | 1 (10%) | 0.9 |
| Time to ROSC [min] | 27 ± 15 | 19 ± 16 | 0.2 |
| Witness (yes) | 11 (100%) | 10 (100%) | 1 |
| Bystander CPR (yes) | 7 (64%) | 7 (70%) | 0.8 |
| Hospital patients on admison data | |||
| GCS score (3–4) | 7 (64%) | 6 (60%) | 0.9 |
| GCS score (5–6) | 4 (36%) | 4 (40%) | 0.9 |
| Medium HR [bpm] | 102 ± 26 | 98 ± 13 | 0.7 |
| Medium MAP [mmHg] | 94 ± 26 | 96 ± 23 | 0.9 |
| Cardiogenic shock (yes) | 3 (27%) | 1 (10%) | 0.3 |
| Time to MTH [min] | 117 ± 37 | 154 ± 66 | 0.2 |
| STEMI location | |||
| Anterior | 5 (45%) | NA | |
| Inferior | 2 (18%) | NA | |
| Lateral | 1 (9%) | NA | |
| Anterior-lateral | 2 (18%) | NA | |
| Inferior-lateral | 1 (9%) | NA | |
| LBBB | 0 | 2 (20%) | 0.1 |
| RBBB | 2 (18%) | 2 (20%) | 0.9 |
| Coronary angiographic | |||
| Culprit leasion: | |||
| Left main artery | 0 (0%) | 0 (0%) | – |
| Left anterior descending artery | 6 (55%) | 2 (20%) | 0.1 |
| Diagonal artery | 0 (0%) | 1 (10%) | 0.3 |
| Intermediate artery | 1 (9%) | 0 (0%) | 0.3 |
| Left circumfex artery | 1 (9%) | 2 (20%) | 0.5 |
| Marginal artery | 2 (18%) | 2 (20%) | 0.9 |
| Right coronary artery | 1 (9%) | 2 (20%) | 0.5 |
| MVD (more than 1-VD) | 0 (%) | 1 (10%) | 0.3 |
| Culprit occlusions | 8 (73%) | 4 (40%) | 0.1 |
| Intervention findings | |||
| PCI | 10 (91%) | 10 (100%) | 0.3 |
| PCI type: | |||
| Bare metal stent | 1 (9%) | 0 (0%) | 0.3 |
| Drug eluting stent | 9 (82%) | 10 (100%) | 0.2 |
| Used of GP IIb/IIIa inhibitors | 1 (9%) | 0 (0%) | 0.3 |
| Time from cardiac arrest to door to balloon [min] | 107 ± 33 | 155 ± 68 | 0.06 |
| Time PCI [min] | 29 ± 18 | 18 ± 9 | 0.1 |
| Hospital patients at discharge | |||
| Echocardiogram: | |||
| Normal (EF > 50%) | 6 (55%) | 4 (40%) | 0.5 |
| Mild-moderate (EF 30–49%) | 3 (27%) | 6 (60%) | 0.1 |
| Severe (EF < 30%) | 2 (18%) | 0 (0%) | 0.2 |
| Medication | |||
| ASA | 10 (91%) | 8 (80%) | 0.5 |
| Clopidogrel | 0 (0%) | 1 (10%) | 0.3 |
| Ticagrelor | 11 (100%) | 9 (90%) | 0.3 |
| LMWH | 3 (27%) | 6 (60%) | 0.1 |
| Statin | 4 (36%) | 7 (70%) | 0.1 |
| ACEI | 6 (54%) | 5 (50%) | 0.8 |
| Digoxin | 0 (0%) | 1 (10%) | 0.3 |
| Beta-blocker | 6 (54%) | 4 (40%) | 0.5 |
| Diuretic | 8 (72%) | 5 (50%) | 0.3 |
| Cordarone | 1 (9%) | 1 (10%) | 0.9 |
| Clinical characteristics | |||
| Cerebral edema | 1 (9%) | 3 (30%) | 0.2 |
| Stroke | 0 (0%) | 2 (20%) | 0.1 |
| Stent thrombosis | 0 (0%) | 0 (0%) | – |
| Pneumonia | 6 (55%) | 6 (60%) | 0.8 |
| Bleeding | 2 (18%) | 5 (50%) | 0.1 |
| Cardiogenic shock (yes) | 5 (45%) | 4 (40%) | 0.8 |
| Re-cardiac arrest | 3 (27%) | 2 (20%) | 0.7 |
| Neurological outcome | |||
| Good neurological outcome | 7 (64%) | 5 (50%) | 0.5 |
| Death | 2 (18%) | 1 (10%) | 0.6 |
ACEI — angiotensin-converting-enzyme inhibitor; ASA — acetylsalicylic acid; CPR — cardiopulmonary resuscitation; EF — ejection fraction; GCS — Glasgow Coma Scale; GP — glycoprotein; HR — heart rate; LBBB — left bundle branch block; LMWH — low molecular weight heparin; MAP — mean arterial pressure; MTH — mild therapeutic hypothermia; MVD — multivessel disease; NSTEMI — non-ST-segment elevation myocardial infarction; PCI — percutaneous coronary intervention; RBBB — right bundle branch block; ROSC — return of spontaneous circulation; STEMI — ST-segment elevation myocardial infarction; VT/VF — ventricular tachycardia/ventricular fibrillation
Due to STEMI, patients were admitted directly to a catheterization laboratory (without additional diagnostic tests), and STEMI vs. NSTEMI groups were compared. No significant differences between groups were observed: (1) the main mechanism of cardiac arrest was ventricular fibrillation; (2) Arterial hypertension was the most commonly occurring risk factor for atherosclerosis in both groups; (3) Time frame to balloon was longer in NSTEMI patients (delay of revascularization resulted from the exclusion of non-cardiogenic reasons of cardiac arrest; p = 0.06); (4) In the STEMI group, > 50% left anterior descending artery was due to infarct-related artery; (5) Cardiogenic shock occurred at the same frequency in both groups (45% vs. 40%; p = 0.8); (6) The bleeding rates were greater in NSTEMI (STEMI vs. NSTEMI, 18% vs. 50%; p = 0.1); and (7) The number of favourable neurological outcomes (as identified by the Pittsburgh Cerebral Performance Category scores 1 and 2) were similar in patients in both groups (64% vs. 50%; p = 0.5).