A patient with an acute myocardial infarction after successful cardiopulmonary resuscitation - Thrombolysis or primary coronary intervention?

After successful resuscitation from cardiac arrest, patients with an ST-elevation myocardial infarction have three options: no immediate reperfusion, systemic thrombolysis or primary percutaneous coronary intervention (PPCI). In the present review, we analyzed the published data on outcome, neurologically intact survival and complications (e.g., bleeding). Results We found that total survival is better with PPCI (61%) as compared to thrombolysis (54%) or no reperfusion (40%). Neurologically intact survival (cerebral performance category of 1 or 2 at discharge or > 6 months) is found more often in thrombolyzed patients (54%) than in patients with PPCI (49%) or without reperfusion therapy (37%). Bleeding complications are not different from patients who have not been resuscitated and have no relevant influence on outcome, even if therapeutic hypothermia is applied. Conclusion Systemic thrombolysis for patients after successful cardiopulmonary resuscitation with ST-elevation myocardial infarction leads to a better rate of patients with neurologically intact survival compared to primary coronary intervention or to conservative treatment without reperfusion. © 2009 Spinger.