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

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.

[1]  P. Lurz,et al.  Angiography after Out-of-Hospital Cardiac Arrest without St-Segment Elevation , 2022, The Journal of Emergency Medicine.

[2]  M. Holzer,et al.  Association of Timing of Electrocardiogram Acquisition After Return of Spontaneous Circulation With Coronary Angiography Findings in Patients With Out-of-Hospital Cardiac Arrest , 2021, JAMA network open.

[3]  Correction to: Randomized Pilot Clinical Trial of Early Coronary Angiography Versus No Early Coronary Angiography After Cardiac Arrest Without ST-Segment Elevation: The PEARL Study. , 2020, Circulation.

[4]  M. Ong,et al.  Incidence and Outcomes of Out‐of‐Hospital Cardiac Arrest in Singapore and Victoria: A Collaborative Study , 2020, Journal of the American Heart Association.

[5]  S. Kapadia,et al.  Coronary Angiography in Patients With Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation: A Systematic Review and Meta-Analysis. , 2020, JACC. Cardiovascular interventions.

[6]  Francesca N. Delling,et al.  Heart Disease and Stroke Statistics—2020 Update: A Report From the American Heart Association , 2020, Circulation.

[7]  Ulf J Jensen,et al.  Direct or subacute coronary angiography in out-of-hospital cardiac arrest (DISCO)-An initial pilot-study of a randomized clinical trial. , 2019, Resuscitation.

[8]  H. Crijns,et al.  Coronary Angiography after Cardiac Arrest without ST‐Segment Elevation , 2019, The New England journal of medicine.

[9]  S. Girotra,et al.  Early coronary angiography and survival after out-of-hospital cardiac arrest: a systematic review and meta-analysis , 2018, Open Heart.

[10]  A. Sahlén,et al.  First Medical Contact-to-Device Time and Heart Failure Outcomes Among Patients Undergoing Primary Percutaneous Coronary Intervention , 2018, Circulation. Cardiovascular quality and outcomes.

[11]  G. Perkins,et al.  Regional variation in the characteristics, incidence and outcomes of out-of-hospital cardiac arrest in Australia and New Zealand: Results from the Aus-ROC Epistry. , 2018, Resuscitation.

[12]  C. Callaway,et al.  Early coronary angiography and percutaneous coronary intervention are associated with improved outcomes after out of hospital cardiac arrest. , 2018, Resuscitation.

[13]  M. Khan,et al.  Early coronary angiography in patients resuscitated from out of hospital cardiac arrest without ST-segment elevation: A systematic review and meta-analysis. , 2017, Resuscitation.

[14]  Gavin D Perkins,et al.  EuReCa ONE-27 Nations, ONE Europe, ONE Registry: A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe. , 2016, Resuscitation.

[15]  K. Song,et al.  Association of emergent and elective percutaneous coronary intervention with neurological outcome and survival after out-of-hospital cardiac arrest in patients with and without a history of heart disease. , 2015, Resuscitation.

[16]  B. McNally,et al.  Early Coronary Angiography and Survival After Out-of-Hospital Cardiac Arrest , 2015, Circulation. Cardiovascular interventions.

[17]  J. Chiche,et al.  Immediate Percutaneous Coronary Intervention Is Associated With Improved Short- and Long-Term Survival After Out-of-Hospital Cardiac Arrest , 2015, Circulation. Cardiovascular interventions.

[18]  Barbara T. Unger,et al.  Outcomes of Comatose Cardiac Arrest Survivors With and Without ST-Segment Elevation Myocardial Infarction: Importance of Coronary Angiography. , 2015, JACC. Cardiovascular interventions.

[19]  C. Hassager,et al.  Survival in patients without acute ST elevation after cardiac arrest and association with early coronary angiography: a post hoc analysis from the TTM trial , 2015, Intensive Care Medicine.

[20]  V. Randhawa,et al.  Cardiac catheterization is associated with superior outcomes for survivors of out of hospital cardiac arrest: review and meta-analysis. , 2014, Resuscitation.

[21]  D. Walters,et al.  Routine angiography in survivors of out of hospital cardiac arrest with return of spontaneous circulation: a single site registry , 2014, BMC Cardiovascular Disorders.

[22]  A. Cohen-Solal,et al.  Favourable 5-year postdischarge survival of comatose patients resuscitated from out-of-hospital cardiac arrest, managed with immediate coronary angiogram on admission , 2014, European heart journal. Acute cardiovascular care.

[23]  M. Ong,et al.  Pan-Asian Resuscitation Outcomes Study (PAROS): rationale, methodology, and implementation. , 2011, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[24]  C. Lory,et al.  Impact of routine percutaneous coronary intervention after out-of-hospital cardiac arrest due to ventricular fibrillation , 2011, Critical care.

[25]  R. Berg,et al.  Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies. , 2010, Resuscitation.

[26]  J. Nolan,et al.  Part 9: Acute coronary syndromes: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. , 2010, Resuscitation.

[27]  X. Jouven,et al.  Immediate Percutaneous Coronary Intervention Is Associated With Better Survival After Out-of-Hospital Cardiac Arrest: Insights From the PROCAT (Parisian Region Out of Hospital Cardiac Arrest) Registry , 2010, Circulation. Cardiovascular interventions.

[28]  R. Neumar,et al.  Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Str , 2008, Circulation.

[29]  C. Tracy,et al.  Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. , 2006 .

[30]  Dan M. Roden,et al.  ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines , 2006 .

[31]  D. Zahger.  Immediate coronary angiography in survivors of out-of-hospital cardiac arrest. , 1997, The New England journal of medicine.

[32]  C. Callaway,et al.  Part 8: Post–Cardiac Arrest Care , 2017 .

[33]  X. Jouven,et al.  Immediate Percutaneous Coronary Intervention Is Associated With Better Survival After Out-of-Hospital Cardiac Arrest Insights From the PROCAT (Parisian Region Out of Hospital Cardiac Arrest) Registry , 2010 .