OHCA patients undergoing on-admission CA had a very favourable postdischarge survival. Patients with OHCA due to ACS had better survival to discharge at 5-year follow up than patients with OHCA due to other causes.

Limited data are available regarding the optimal therapeutic regimen in patients undergoing TAVI who need therapy for AF. Carefully designed clinical studies might further clarify the incidence and interrelation between atrial fibrillation and TAVI. The balance between the efficacy and risk of anticoagulation needs to be further clarified in patients undergoing TAVI.

Background Survival after out-of-hospital cardiac arrest (OHCA) remains poor. Acute coronary obstruction is a major cause of OHCA. We hypothesize that early coronary reperfusion will improve 24h-survival and neurological outcomes. Methods Total occlusion of the mid LAD was induced by balloon inflation in 27 pigs. After 5 minutes, VF was induced and left untreated for 8 minutes. If return of spontaneous circulation (ROSC) was achieved within 15 minutes (21/27 animals) of cardiopulmonary resuscitation (CPR), animals were randomized to a total of either 45 minutes (group A) or 4 hours (group B) of LAD occlusion. Animals without ROSC after 15 minutes of CPR were classified as refractory VF (group C). In those pigs, CPR was continued up to 45 minutes of total LAD occlusion at which point reperfusion was achieved. CPR was continued until ROSC or another 10 minutes of CPR had been performed. Primary endpoints for groups A and B were 24-hour survival and cerebral performance category (CPC). Primary endpoint for group C was ROSC before or after reperfusion. Results Early compared to late reperfusion improved survival (10/11 versus 4/10, p= 0.02), mean CPC (1.4±0.7 versus 2.5±0.6, p= 0.017), LVEF (43±13 versus 32±9%, p=0.01), troponin I (37±28 versus 99±12, p=0,005) and CK-MB (11 ±4 versus 20.1±5, p=0.031) at 24-hr after ROSC. ROSC was achieved in 4/6 animals only after reperfusion in group C. Conclusions Early reperfusion after ischemic cardiac arrest improved 24h survival rate and neurological function. In animals with refractory VF, reperfusion was necessary to achieve ROSC.

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