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Long-term prognosis after out-of-hospital cardiac arrest with/without ST elevation myocardial infarction
Authors:Miloslav Pleskot  Radka Hazukova  Hana Stritecka  Eva Cermakova  Radek Pudil
Affiliation:1. 1st Department of Internal Medicine, University Hospital, Faculty of Medicine in Hradec Kralove, Charles University in Prague, Sokolska 581, 500 05 Hradec Kralove, Czech Republic;2. Faculty of Military Health Sciences, University of Defence in Hradec Kralove, Czech Republic;3. Computer Technology Center, Department of Medical Biophysics, Faculty of Medicine in Hradec Kralove, Charles University in Prague, Czech Republic
Abstract:

Aim

To describe the 3-year survival of patients after out-of-hospital cardiac arrest (OHCA) taking into account the presence of ST-segment elevation myocardial infarction (STEMI) and evaluating prognostic factors associated with pre-hospital and hospital care.

Patient group

Over a period of 29 months and with the aid of a questionnaire supplied to 24 rescue stations, we prospectively included 560 individuals (415 men; aged 16–97 years, median 68) for whom cardio-pulmonary resuscitation (CPR) for OHCA of confirmed cardiac etiology was attempted.

Results

Of 149 hospitalized individuals, 28.2% survived 1 year and 25.5% survived 3 years after OHCA. In the subgroup of patients with STEMI (26 individuals; 17.5%), 57.7% survived 1 year and 53.9% survived 3 years. In the subgroup of patients without STEMI (n = 123), 22% survived 1 year and 19.5% survived 3 years. The strongest predictors for long-term survival by logistic regression analysis were: age under 70 years, ventricular fibrillation as initial rhythm, CPR without atropine, and STEMI. OHCA occurrence at a public place was an indicator of better survival in the subgroup with STEMI. In the subgroup of patients without STEMI, long-term angiotensin-converting enzyme inhibitor treatment, CPR without atropine, a Glasgow Coma Scale upon hospital admission over 3, no presence of cardiogenic shock, and no manifestations of postanoxic encephalopathy (Fisher's exact test, χ2 test) were indicators of better survival.

Conclusion

Among 560 individuals with “primary cardiac” etiology OHCA and initiation of professional CPR, 8% survived 1 year and 7% survived 3 years. A higher survival rate among patients with STEMI was documented.
Keywords:Cardiac arrest   Out-of-hospital   Myocardial infarction   ST-segment elevation myocardial infarction   Sudden cardiac death
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