PCI in patients after cardiac arrest without extracadiac causes

Should we perform percutaneous coronary interventions (PCIs) in every patient after cardiac arrest with no obvious extracardiac cause?

Bernd W. Böttiger: This is a very good question and we do not really know the exact answer. What we know is that at least in the case of patients with out-of-hospital cardiac arrest, 60% to 70% of them are collapsing because they have an acute coronary syndrome or an acute myocardial infarction; in these patients, it would be necessary and useful to do PCI procedures, but we do not exactly know which patients [belong to this group and will benefit from PCI] and which patients will probably not profit from PCI.

What we recommend in the new guidelines is that all patients with ST-segment elevation after cardiac arrest in the out-of-hospital setting and also in the in-hospital setting should go to a PCI lab. Patients with a new left bundle branch block should go there, and maybe other patients where the doctors have the feeling, or the strong feeling, that acute coronary syndrome is an underlying cause of deterioration.