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Percutaneous coronary intervention (PCI) after successful reestablishment of spontaneous circulation and during cardiopulmonary resuscitation

2007; Cambridge University Press; Linguagem: Inglês

10.1017/cbo9780511544828.044

Marko Noč, Bjørn Bendz, Karl B. Kern,

Cardiovascular Effects of Exercise

Coronary artery disease represents the most important cause of out-of-hospital cardiac arrest. Immediate coronary angiography in patients after reestablishment of spontaneous circulation demonstrated angiographic evidence of coronary artery disease in 80% of patients, with the majority (90%) having significant obstructive stenoses of one or more coronary arteries. Experimental animal models have shown that coronary obstructions have a profound effect on the utility of cardiopulmonary resuscitation to perfuse the myocardium during cardiac arrest. We found that coronary diameter stenoses as little as 33% decreased distal perfusion by more than half (see Chapter 18 for more details). Postmortem examinations of sudden cardiac death victims indicate that unstable plaque with associated coronary thrombosis may be documented in more than 80% of the cases. Accordingly, acute coronary thrombotic events leading to critical narrowing or complete coronary obstruction and possibly distal microembolization may be a main trigger of sudden arrhythmic cardiac arrest.