1/ This is a very important and courageous study. Forever cardiologists have shunned emergency PCI for cardiac arrest because it will mess up their numbers. Even with STEMI.
nejm.org/doi/full/10.10…
nejm.org/doi/full/10.10…
2/ Interventional cardiologists are graded by mortality rates. So OHCA patients have always been a PCI do-not-touch scenario. Even though we know that many arrests result from ACS.
3/ This led to an incredible realization for me, according to the great Karl Kern, that acute coronary occlusions do not always lead to STEMI. Cardiologists rely on STEMI to trigger emergency PCI because it is specific and reliable for ACS.
4/ Some acute coronary occlusions manifest as cardiac arrest without STEMI. So why not try emergency PCI for all OHCA? This study is a bold foray into this question.
5/ It would seem that routine PCI saves lives, but at the cost of worse neurological outcomes. My guess is that the craziness of the intervention might intefere with the brain protection.
6/ I’m not even saying hypothermia. Which might help or might not. Hypotension and desats can also injure the post arrest brain. The reperfused ischemic brain is pretty sensitive.
7/ My buddy @emcrit Scott Weingart made the observation that coronary syndromes especially like to cause VF arrest. So maybe the next step is a similar study restricted to shockable rhythms? /end
@threadreaderapp unroll
• • •
Missing some Tweet in this thread? You can try to
force a refresh
