Percutaneous coronary intervention after return of spontaneous circulation following in-hospital cardiac arrest with evidence of acute myocardial infarction & its neurological outcome

Objectives Acute myocardial infarction (AMI) is a major cause of cardiac arrest. Immediate coronary angiography and percutaneous coronary intervention (PCI) may be considered in patients who have been successfully resuscitated after cardiac arrest with pre or post-cardiac arrest documentary evidence of AMI. This study aimed to evaluate the effects of PCI on in-hospital mortality and neurological outcomes after gaining return of spontaneous circulation (ROSC) following cardiac arrest due to AMI. Material and Methods In this prospective observational cohort study, we randomly assigned 36 patients from August 2021 to November 2023 who had a cardiac arrest either at emergency or in patient department during ongoing care with evidence of AMI. We treated all patients with coronary intervention and supportive care including inpatient care and outpatient follow-up in 30 and 90 days to evaluate neurological outcomes. Results All 36 patients underwent immediate coronary angiogram (CAG) after ROSC followed by newer generation drug eluting stent (DES) implantation. The mean age of the patients was 55.39±10.89 years. Among them male was 32(88.88%), female was 4(11.11%). Smoking (77.78%) was the most common risk factor followed by diabetes mellitus (72.2%), hypertension (66.7%), dyslipidaemia (55.6%), positive family history of ischemic heart disease (IHD) (38.9%), and chronic kidney disease (38.9%) patients. Among all patients, 22(61.1%) patients had acute st-segment elevated myocardial infarction (STEMI) (anterior). Ten (27.8%) patients had acute STEMI (inferior), and four (11.1%) had acute non-st-segment elevated myocardial infarction (NSTEMI). Single vessel coronary artery disease (SVD) was found in 22 (61.1%) patients, Double Vessel Coronary Artery Disease (DVD) in 8 (22.2%) patients, and triple vessel coronary artery disease (TVD) in 6 (16.7%) patients. Thirty-two patients got target vessel revascularization and four patients got total revascularization. Cardiac arrest hospital prognosis (CAHP) Score was done in all cases. Based on the score only a low (≤150) score was selected. Based on the cerebral performance category (CPC), three (8.3%) patients developed CPC-5 and died. Among the survivals pre-discharge CPC-1 was 30(83.3), CPC-2 was 01(2.8), and CPC-3 was 2 (5.5). Patient with CPC-2 was improved without any neurological deficit on 30 days follow-up. Among the CPC-3 patients, one patient died and another patient persists with mild neurological deficit. The survival and neurological outcomes were statistically significant (p<0.05). Conclusion The patients who gained ROSC after cardiac arrest caused by AMI and underwent PCI had lower in-hospital mortality and satisfactory neurological outcomes.