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. 2015 Oct;8(10):e002321.
doi: 10.1161/CIRCINTERVENTIONS.114.002321.

Early Coronary Angiography and Survival After Out-of-Hospital Cardiac Arrest

Ankur Vyas  1 , Paul S Chan  2 , Peter Cram  2 , Brahmajee K Nallamothu  2 , Bryan McNally  2 , Saket Girotra  2
Affiliations

Early Coronary Angiography and Survival After Out-of-Hospital Cardiac Arrest

Ankur Vyas et al. Circ Cardiovasc Interv. 2015 Oct.

Abstract

Background: Although out-of-hospital cardiac arrest is common because of acute myocardial infarction, it is unknown whether early coronary angiography is associated with improved survival in these patients.

Methods and results: Using data from the Cardiac Arrest Registry to Enhance Survival (CARES), we identified 4029 adult patients admitted to 374 hospitals after successful resuscitation from out-of-hospital cardiac arrest because of ventricular fibrillation, pulseless ventricular tachycardia, or unknown shockable rhythm between January 2010 and December 2013. Early coronary angiography (occurring within one calendar day of cardiac arrest) was performed in 1953 (48.5%) patients, of whom 1253 (64.2%) received coronary revascularization. Patients who underwent early coronary angiography were younger (59.9 versus 62.0 years); more likely to be men (78.1% versus 64.3%), have a witnessed arrest (84.6% versus 77.4%), and have ST-segment-elevation myocardial infarction (32.7% versus 7.9%); and less likely to have known cardiovascular disease (22.8% versus 35.0%), diabetes mellitus (11.0% versus 17.0%), and renal disease (1.8% versus 5.8%; P<0.01 for all comparisons). In analysis of 1312 propensity score-matched pairs, early coronary angiography was associated with higher odds of survival to discharge (odds ratio 1.52 [95% confidence interval 1.28-1.80]; P<0.0001) and survival with favorable neurological outcome (odds ratio 1.47 [95% confidence interval 1.25-1.71]; P<0.0001). Further adjustment for coronary revascularization in our models significantly attenuated both odds ratios, suggesting that revascularization was a key mediator of the survival benefit.

Conclusions: Among initial survivors of out-of-hospital cardiac arrest caused by VF or pulseless VT, we found early coronary angiography was associated with higher odds of survival to discharge and favorable neurological outcome.

Keywords: cardiac arrest; cardiac catheterization; coronary angiography; diabetes mellitus; out-of-hospital cardiac arrest.

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Figures

Figure 1
Figure 1
Study cohort VF: Ventricular Fibrillation; VT: Ventricular Tachycardia; ROSC: Return of Spontaneous Circulation;
Figure 2
Figure 2
Standardized differences between cohorts before and after propensity score matching AED: Automatic External Defibrillator; CPR: Cardio-pulmonary Resuscitation; SD: standard deviation; STEMI: ST-Elevation Myocardial Infarction; Before propensity matching, there were significant differences in a number of variables between patients who did and did not receive early coronary angiography (standardized differences > 10%). After propensity matching, the standardized difference for all variables was < 10% suggesting that propensity matching was successful in achieving covariate balance. Variables are presented in the descending order of magnitude of standardized differences prior to propensity matching.
See this image and copyright information in PMC

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