Blood-pressure targets in comatose survivors of cardiac arrest with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention - a BOX sub-study

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main source(s): Novo Nordisk Background After successful resuscitation from out-of-hospital cardiac arrest (OHCA), patients who remain comatose often need hemodynamic support with vasoactive drugs in order to secure an adequate perfusion pressure vital organs. However, evidence regarding specific blood-pressure targets is sparse, and concomitant heart disease such as acute ST-elevation myocardial infarction (STEMI) might benefit a lower afterload doses drugs. Purpose To assess the impact on biochemical infarct size survivors OHCA STEMI and, further, investigate whether high or low mean arterial target superior preventing death severe brain injury. Methods The BOX study (n=789) randomized trial 2-by-2 factorial design which evaluated double-blind intervention (77 mmHg) versus (63 presumed cause. In this pre-specified sub-study we included had initial electrocardiogram recorded after return spontaneous circulation (ROSC). primary outcome was creatine kinase (CK), MB (CKMB), troponin T (TnT) levels measured at 48 hours surrogate markers size. A secondary composite all-cause within one year admission discharge hospital Cerebral Performance Category (CPC) 3 4, indicating neurological disability vegetative state. Results total 350 were included. Mean time ROSC 21±13 minutes. age 63±12 years approximately 4 out 5 male. prevalence relevant prior medical history follows; hypertension 42%, diabetes 12%, chronic ischemic 20%, percutaneous coronary 11%, artery bypass grafting 4%, congestive failure 10%. CK, CKMB TnT did not differ between two groups (p=0.42, p=0.14 p=0.65, respectively). Within year, 138 (39%) died been discharged CPC no difference found blood (hazard ratio, 1.02; 95% CI, 0.73-1.43; p=0.9). Conclusion Targeting affect estimated by biomarkers nor it result significant neurologic disability. Although evaluating side effects, thus suggests that use pharmacologic circulatory post-resuscitation care can be limited.