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. 2021 Nov 6;10(21):5191.
doi: 10.3390/jcm10215191.

Early Coronary Angiography Is Associated with Improved 30-Day Outcomes among Patients with Out-of-Hospital Cardiac Arrest

Shir Lynn Lim  1 , Yee How Lau  2 , Mark Y Chan  1 , Terrance Chua  2 , Huay Cheem Tan  1 , David Foo  3 , Zhan Yun Lim  4 , Boon Wah Liew  5 , Nur Shahidah  6 , Desmond R Mao  7 , Si Oon Cheah  8 , Michael Y C Chia  9 , Han Nee Gan  10 , Benjamin S H Leong  11 , Yih Yng Ng  9   12 , Khung Keong Yeo  2 , Marcus E H Ong  6   13
Affiliations

Early Coronary Angiography Is Associated with Improved 30-Day Outcomes among Patients with Out-of-Hospital Cardiac Arrest

Shir Lynn Lim et al. J Clin Med. .

Abstract

We evaluated the association between early coronary angiography (CAG) and outcomes in resuscitated out-of-hospital cardiac arrest (OHCA) patients, by linking data from the Singapore Pan-Asian Resuscitation Outcomes Study, with a national registry of cardiac procedures. The 30-day survival and neurological outcome were compared between patients undergoing early CAG (within 1-calender day), versus patients not undergoing early CAG. Inverse probability weighted estimates (IPWE) adjusted for non-randomized CAG. Of 976 resuscitated OHCA patients of cardiac etiology between 2011-2015 (mean(SD) age 64(13) years, 73.7% males), 337 (34.5%) underwent early CAG, of whom, 230 (68.2%) underwent PCI. Those who underwent early CAG were significantly younger (60(12) vs. 66(14) years old), healthier (42% vs. 59% with heart disease; 29% vs. 44% with diabetes), more likely males (86% vs. 67%), and presented with shockable rhythms (69% vs. 36%), compared with those who did not. Early CAG with PCI was associated with better survival and neurological outcome (adjusted odds ratio 1.91 and 1.82 respectively), findings robust to IPWE adjustment. The rates of bleeding and stroke were similar. CAG with PCI within 24 h was associated with improved clinical outcomes after OHCA, without increasing complications. Further studies are required to identify the characteristics of patients who would benefit most from this invasive strategy.

Keywords: 30-day survival; coronary angiography; neurological outcomes; out-of-hospital cardiac arrest; percutaneous coronary intervention.

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Conflict of interest statement

S.L.L. is supported by the National University Health System Clinician Scientist Program—she has received research grants from the National University Health System, the National Kidney Foundation of Singapore, and the Singapore Heart Foundation. M.E.H.O. reports: funding from the Zoll Medical Corporation for a study involving mechanical cardiopulmonary resuscitation devices; grants from the Laerdal Foundation, Laerdal Medical, and Ramsey Social Justice Foundation for funding of the Pan-Asian Resuscitation Outcomes Study; an advisory relationship with Global Healthcare SG, a commercial entity that manufactures cooling devices; and funding from Laerdal Medical on an observation program to their Community CPR Training Centre Research Program in Norway. M.E.H.O. has a licensing agreement and patent filed (application no: 13/047,348) with ZOLL Medical Corporation for a study titled “Method of predicting acute cardiopulmonary events and survivability of a patient.” All other authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Patient selection. * Refers to the study population. Abbreviations: OHCA, out-of-hospital cardiac arrest; EMS, Emergency Medical Services; ED, Emergency Department.
Figure 2
Figure 2
Kaplan–Meier survival curve. Abbreviations: CAG, coronary angiography; PCI, percutaneous coronary intervention.
Figure 3
Figure 3
Associations between early CAG, with and without immediate PCI, and outcomes. No or delayed CAG was taken as the reference group. Abbreviations: CAG, coronary angiography; PCI, percutaneous coronary intervention; IPWE, inverse probability weighted estimator; CPC, cerebral performance category.
See this image and copyright information in PMC

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