Cardiac arrest in patients with coronary artery disease. Claude LE FEUVRE Institut de Cardiologie Pitié-Salpêtrière

Transcription

1 Cardiac arrest in patients with coronary artery disease Claude LE FEUVRE Institut de Cardiologie Pitié-Salpêtrière

2 Disclosure Statement of Financial Interest I currently have, or have had over the last two years, an affiliation or financial interests or interests of any order with a company or I receive compensation or fees or research grants with a commercial company : Grant/Research Support: 0 Consulting Fees/Honoraria: 0 Major Stock Shareholder/Equity: 0 Royalty Income: 0 Ownership/Founder: 0 Intellectual Property Rights: 0 Other Financial Benefit: 0

3 Sudden cardiac death incidence and total events

4 Sudden cardiac death and clinical subsets

5 Epidemiology of VT and VF during ACS Half of pts with out-of-hospital cardiac arrest and VF have AMI Of all out-of-hospital cardiac arrest, > 50% will have significant CAD Of pts hospitalized with AMI, 5-10% have VF/sustained VT prior to hospitalization, and 5% after hospital arrival (most < 48H) Predictive factors of VT/VF in AMI (Danish study) Alcohol consumption Preinfarction angina Anterior AMI Complete coronary occlusion at the time of coronary angiography In contrast with prior studies, VT/VF at any time was associated with higher 3 months death rate (higher risk in pts with VT/VF > 48h than < 48h)

6 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation

7 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation Urgent angiography (within 2H after cardiac arrest) in pts without STEMI High suspicion of ongoing infarction Chest pain before arrest History of CAD Abnormal ECG Exclusion of non-coronary causes Cerebrovascular event, non-cardiogenic shock, pulmonary embolism, intoxication Urgent echocardiography Factors associated with poor neurological outcome Unwitnessed cardiac arrest Late arrival of a pre-hospital team without basic life-support (> 10 min) Initial non-shockable rhythm More than 20 min of advenced life support without return of spontaneous circulation

8 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation

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14 Recommendations for pts with coronary spasm 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

15 Secondary prevention patients with ischemic heart disease 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

16 Treatment of recurrent VA in pts with ischemic heart disease 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

17 Treatment of recurrent VA in pts with ischemic heart disease 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

18 Treatment of recurrent VA in pts with ischemic heart disease 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

19 Primary prevention of SCD in pts with ischemic heart disease 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

20 Primary prevention of SCD in pts with ischemic heart disease 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

21 Primary prevention of SCD in pts with ischemic heart disease 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

22 FAST-MI program ESC 2017 N Danchin, E Puymirat, F Schiele on behalf the USIK, USIC 2000, FAST-MI investigators Six-month mortality in STEMI pts Six-month mortality in NSTEMI pts

23 Survival rates after out of hospital cardiac arrest French registry RéAC-SFAR-SFMU, FFC, DGS pts between 2011 and 2017 Death rate at hospital admission Death rate at 1 month ,3% 92,9% ,1% 92,5% ,4% 92,7% ,1% 92,9% ,9% 92,9% ,4% 93% ,2% 93,6%

24 Cardiac arrest : how could we improve survival? 2014 CESE, october

25 Cardiac arrest : the ways to improve survival Améliorer la prévention de l arrêt cardiaque Améliorer la formation des familles de pts à risque Améliorer la formation de la population française (école, journée défense et citoyenneté, permis de conduire, vie professionnelle: objectif 70-90%) Priorité aux formations grand public : des modules courts, gratuits (Initiations Premiers Secours) Sessions dans les entreprises, les hôpitaux, les lieux publics

26 Cardiac arrest : the ways to improve survival Débuter la chaîne de survie le plus tôt possible Augmenter le nombre de DAE (immeubles, entreprises, lieux de réunion ) Améliorer le recueil des données RéAC (ministère de la santé, SFMU, SFAR, FFC ) Cartographie des DAE