Complete versus culprit-lesion-only percutaneous coronary intervention after out-of-hospital cardiac arrest in patients with multivessel disease

Abstract

Background: Multivessel coronary artery disease (MVD) represents a common finding at invasive coronary angiography (ICA) among out-of-hospital cardiac arrest (OHCA) survivors. However, optimal invasive treatment strategy for MVD in OHCA remains unknown. Our study aims to assess if complete revascularization improves one-year clinical outcomes in these patients.

Methods: This is a multicentric, prospective, observational study. We considered all OHCA patients enrolled in the Lombardia CARe Registry from January 1, 2015, to December 31, 2022, who underwent ICA in 8 centers in Northern Italy. Clinical follow-up was performed 1 year after the index hospitalization.

Results: Among the 13,354 OHCA patients enrolled, 863 were admitted to the 8 centers involved in the study and ICA was performed in 538 patients. MVD was present in 230 (42.7 %) patients, treated with either complete (77 patients) or incomplete (152 patients) coronary revascularization. At 1 year, death from any cause occurred in 20.8 % of the complete-revascularization group and 53.3 % of the culprit-lesion-only group (p < 0.001), while secondary-outcome event (death from any cause or unfavorable neurological outcome) occurred in 20.8 % and 55.9 %, respectively (p < 0.001). At multivariable analysis, a complete revascularization strategy was independently associated with a reduced risk of death [hazard ratio (HR) 0.29 (95 % confidence intervals (CI): 0.09 to 0.98; p = 0.047)] and death or unfavorable neurological outcome [HR: 0.23 (95 % CI: 0.06 to 0.81; p = 0.022)].

Conclusion: Our findings suggest that a complete percutaneous coronary revascularization strategy is associated with improved one-year survival rates in patients with MVD resuscitated from OHCA.

Keywords: Cardiac arrest; Coronary artery disease; Invasive coronary angiography; Ischemic heart disease; Multivessel disease; Out-of-hospital cardiac arrest; Percutaneous coronary intervention.