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Out-of-hospital cardiac arrest: role of percutaneous coronary intervention

Out-of-hospital cardiac arrest (OHCA) remains the leading cause of death in developed countries, with an annual incidence from 36 to 81 events per 100,000. Prehospital treatment includes immediate recognition, bystander cardiopulmonary resuscitation, defibrillation, and advanced cardiac life support known as a ‘chain of survival’. Owing to improvements in the ‘chain of survival’, the proportion of patients with re-establishment of spontaneous circulation on the field may nowadays exceed 50%. This leads to increased hospital admission observed in communities with mature prehospital emergency services. According to autopsy and immediate coronary angiography (CAG), significant coronary artery disease may be documented in more than 70% of patients. Moreover, in the presence of ST-elevation myocardial infarction (STEMI) in post-resuscitation electrocardiogram, acute thrombotic lesions may be found in up to 90%. However, the absence of STEMI does not exclude obstructive or thrombotic coronary stenosis, which may be present in 25–58% of patients. Because of these findings, interventional cardiologists are increasingly alerted for immediate CAG and percutaneous coronary intervention in OHCA patients.