Early coronary angiography and percutaneous coronary intervention are associated with improved outcomes after out of hospital cardiac arrest. (February 2018)

• Record Type: Journal Article
• Authors: Jentzer, Jacob C.; Scutella, Michael; Pike, Francis; Fitzgibbon, James; Krehel, Nicholas M; Kowalski, Lindsay; Callaway, Clifton W.; Rittenberger, Jon C.; Reynolds, Joshua C.; Barsness, Gregory W.; Dezfulian, Cameron
• Is Part Of: Resuscitation. Volume 123(2018)
• Page Start: 15
• Page End: 21
• Publication Date: 2018-02
• Subjects: ACS acute coronary syndrome -- CABG coronary artery bypass grafting -- CAD coronary artery disease -- CAG coronary angiography -- CPC cerebral performance category -- CPR cardiopulmonary resuscitation -- CXR chest X-ray -- ECG electrocardiography -- HCT head computed tomography scan -- MI myocardial infarction -- mRS modified Rankin scale -- MSOF multi-system organ failure -- OHCA out-of-hospital cardiac arrest -- PCAC Pittsburgh cardiac arrest category -- PCI percutaneous coronary intervention -- ROSC return of spontaneous circulation -- STE ST-segment elevation -- TH therapeutic hypothermia -- UPMC University of Pittsburgh Medical Center -- VF ventricular fibrillation -- VT ventricular tachycardia; Cardiac arrest -- Coronary angiography -- Percutaneous coronary intervention -- Coronary artery disease -- Survival; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2017.12.004
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Aim: Early coronary angiography (CAG) and percutaneous coronary intervention (PCI) are associated with better outcomes in subjects resuscitated from out-of-hospital cardiac arrest (OHCA). We sought to determine the relative contributions of early CAG and PCI to outcomes and adverse events after OHCA. Methods: We analyzed 599 OHCA subjects from a prospective two-center registry. Hospital survival, functional outcomes and adverse events were compared between subjects undergoing early CAG (within 24 h) with or without PCI and subjects not undergoing early CAG. We adjusted for propensity to perform early CAG and PCI and for post-resuscitation illness severity and care. Results: Early CAG subjects had improved rates of hospital survival (56.2% versus 31.0%, OR 2.85 [95% CI 2.04–4.00]; p < 0.0001) and better functional outcomes compared to no early CAG. Early PCI was associated with improved survival compared to early CAG without PCI (65.6% versus 45.5%, OR 2.29 [95% CI 1.41–3.69]; p < 0.001). After multivariate adjustment and propensity matching, early PCI remained significantly associated with improved survival compared with early CAG without PCI and no early CAG, but early CAG without PCI was no longer significantly associated with improved outcome compared with no early CAG. Early CAG and early PCI were not associated with an increase in transfusions or acute kidney injury. Conclusions: Early CAG and PCI are associated with improved survival and functional outcomes after OHCA, but only early PCI was associated with a significant benefit after statistical adjustment. Our analysis supports the performance of immediate CAG to determine the need for PCI in selected patients following resuscitation from OHCA.