The value of two common hospital procedures-cardiopulmonary resuscitation (CPR) after cardiac arrest and percutaneous coronary intervention (PCI) for myocardial infarction-were examined in two recent studies.

CPR: survival rates stagnated. Ehlenbach and colleagues analyzed records of 433,985 Medicare beneficiaries ages 65 and older who underwent in-hospital CPR for cardiac arrest between 1992 and 2005. They found that only 18.3% of patients survived to discharge-a rate that was essentially unchanged in the 13-year time period. Deaths after CPR increased by about 37%, from 3.8% to 5.2%, and the number of patients discharged home after undergoing CPR decreased by almost half.

Survival rates were lower in patients who were male, older, black or nonwhite (nearly 25% lower in blacks), admitted from a skilled nursing facility, admitted into a metropolitan or teaching hospital, or afflicted with a chronic illness.

Although the delivery of in-hospital CPR may have improved over the years, researchers hypothesized that survival rates have stagnated because of "differences in the type or severity of the acute illness leading to CPR"; the increase in the proportion of deaths after CPR may be because the procedure was performed on more patients who were not good candidates for it.

Early PCI: better outcomes. In another study, Cantor and colleagues attempted to determine whether patients who received PCI within six hours of fibrinolysis after an acute myocardial infarction would have a better outcome than those who received only fibrinolysis.

This study was performed at 52 Canadian hospitals unequipped to perform PCI. A total of 1,059 patients with ST-segment elevation myocardial infarction who arrived within 12 hours of symptom onset were treated with fibrinolysis and were randomly assigned to receive either standard treatment (including rescue PCI, if needed) or routine early PCI (accomplished by transfer to another facility) within six hours of fibrinolysis.

The primary end point was a composite of death, reinfarction, recurrent ischemia, new or worsening congestive heart failure, or cardiogenic shock at 30 days. Early-PCI patients had a significant 36% reduction in risk of events covered by the primary end point, which occurred in 11% of the early-PCI group and in 17.2% in the standard treatment group. Early-PCI patients also had significantly lower rates of ischemia and heart failure. Rates of major bleeding or transfusion weren't significantly different between groups.

Tammy Worth