Sudden death resuscitation announcing acute myocardial infarction: early outcome and mortality factors

Between January 1999 and June 2000, we analysed in a prospective study patients admitted for sudden death with positive resuscitation (SD) after acute myocardial infarction (AMI). All patients were assigned to undergo immediate PTCA.

About 588 AMI were recruted during this period, and 38 patients (6.46%) have presented a SD. Mean age of patients of this group is 65.3 years ± 12.3 (37-88). Sex-ratio is 3/1. Patients with Killip grade over III represent 44.7%, and cardiogenic shock is present in 47.3%. Myocardial localisation of infarction is anterior in 60.5%, and inferior in 34.2%. The culpit lesion interests left main coronary artery in 7.9%, LCA in 39.4%, circomflex in 5.3%, and right coronary in 42.1%. An angiographic occluded vessel is present in 94.7%, and we have one-vessel disease in 50.0%, two-vessels disease in 15.8% and three-vessels disease in 34.2%. Successful procedure after PTCA is obtained in 93.5%, with stent implantation in 71.0% of the cases. 53.6% patients are under mechanical ventilation (MV), 31.6% have a cardiac pump assitance by IABP, and 50.0% have β-mimetic medication. In-hospital mortality rate is 31.6%, among which 13.2% in the first day. If we analyse the two groups with or without cardiogenic shock, we obtain:

Conclusion

Mortality rate after successful resuscitation for sudden death during acute myocardial infarction is depending on the haemodynamic status at admission. In presence of cardiogenic shock, two thirds of patients will die. Without shock, no death is observed.

Table 1