AcuteMyocardial Infarction (AMI) is a major cause of cardiac arrest worldwide.Immediate coronary angiography and percutaneous coronary intervention (PCI) maybe considered in patients who have been successfully resuscitated after cardiacarrest with pre or post-cardiac arrest documentary evidence of acute myocardialinfarction. This study aimed to evaluate the effects of PCI on in-hospitalmortality & neurological outcomes after gaining Return of Spontaneous Circulation(ROSC) following cardiac arrest due to AMI. 

Inthis prospective observational cohort study, we have randomly assigned 36patients from August 2021 to November 2023 who had a cardiac arrest either atEmergency or In Patient Department during ongoing care with evidence of acutemyocardial infarction. We collected andanalyzed demographic, clinical, and procedural data, and outcomes includingsurvival rates and neurological status assessed by standardized scales (e.g.GCS, Motor/Sensory function, cognitive function and Gait) to measure CerebralPerformance Category (CPC). All patients had a CT scan/MRI of the brain duringtheir hospital stay or before discharge.Wetreated all patients with coronary intervention and supportive care includinginpatient care and outpatient follow-up in 30 and 90 days to evaluateneurological outcomes. We only include patientswho gained consciousness or neurological response following ROSC, Comatosepatients were excluded due to its relevancy with other supportive care factors.In all cases, AMI was confirmed by ECG and/or troponin-i, immediate CAG wasattempted and coronary perfusion was established by PCI.After gaining ROSC, patientsshifted to Cath lab as early as possible. From Emergency Room or from InPatient Department to Needle time average 32±8 minutes. Femoral route waspreferred over radial. Thrombosuction employed only for the selectedcase with heavy thrombus load.  Average procedure time 28±6 in targetvessel revascularization. In all cases Iodixanol was used. 8 patients needs temporary pacemaker supportswhich was withdrawn post procedurally accordingly. 

Themean age of the patients was 55.39±10.89 years. Among them male was32(88.88%), female was 4(11.11%). Smoking (77.78%) was the most common riskfactor followed by Diabetes mellitus (72.2%), Hypertension (66.7%),Dyslipidemia (55.6%), positive family history of IHD (38.9%), chronic kidneydisease (38.9%) & Bronchial Asthma (33.9%) patients. Among all patients,22(61.1%) patients had Acute STEMI (Anterior). 10(27.8%) patients had AcuteSTEMI (Inferior) & 4 (11.1%) had acute NSTEMI. SVD was found in 22(61.1%)patients, DVD in 08(22.2%) patients and TVD in 6(16.7%) patients. (Table-1)All 36 patients underwent immediate Coronary Angiogram (CAG) after ROSCfollowed by newer generation Drug Eluting Stent (DES) implantation. 32 patientsgot target vessel revascularization & 4 patients got total revascularization.In all patients with CT or MRI of brain was done as per advice of Neurologist. Cardiac Arrest Hospital Prognosis (CAHP) Score was donein all cases. Based on the score only low (≤150) score was selected. Cerebralperformance category (CPC) was assessed in all cases. 3(8.3%) patientsdeveloped CPC-5 & were death. 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 improvedwithout any neurological deficit on 30 days follow up. Among the CPC- 3patients one patient was died & another patient persist mild neurologicaldeficit. (Table-2)The in-hospitalsurvival was statistically significant after PCI (p<0.05). Neurologicaloutcome is survived patients was also statistically significant (p<0.05) (Table-3)

The patients who gained ROSC after cardiac arrestcaused by AMI & underwent PCI had a lower in-hospital mortality &satisfactory neurological outcomes.