Impact of Emergency Coronary Angiography on In-Hospital Outcome of Unconscious Survivors After Out-of-Hospital Cardiac Arrest

• Published in: The American journal of cardiology 2012-12, Vol.110 (12), p.1723-1728
• Main Authors: Zanuttini, Davide, MD, Armellini, Ilaria, MD, Nucifora, Gaetano, MD, Carchietti, Elio, MD, Trillò, Giulio, MD, Spedicato, Leonardo, MD, Bernardi, Guglielmo, MD, Proclemer, Alessandro, MD
• Format: Article
• Language: English
• Subjects: Aged; Angina pectoris; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiology. Vascular system; Cardiopulmonary Resuscitation - methods; Cardiopulmonary Resuscitation - mortality; Cardiovascular; Cardiovascular disease; Cardiovascular system; Coronary Angiography; Coronary vessels; Emergency Service, Hospital; Emergency Treatment; Female; Heart attacks; Hospital Mortality; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Out-of-Hospital Cardiac Arrest - diagnostic imaging; Out-of-Hospital Cardiac Arrest - mortality; Out-of-Hospital Cardiac Arrest - therapy; Prognosis; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Survival Rate; Unconsciousness
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2012.08.006

Acute coronary thrombotic occlusion is the most common trigger of cardiac arrest. The aim of the present study was to assess the impact of an invasive strategy characterized by emergency coronary angiography and subsequent percutaneous coronary intervention (PCI), if indicated, on in-hospital survival of resuscitated patients with out-of-hospital cardiac arrest (OHCA) and no obvious extracardiac cause who do not regain consciousness soon after recovery of spontaneous circulation. Ninety-three consecutive patients (67 ± 12 years old, 76% men) were included in the study. Clinical characteristics and coronary angiographic and in-hospital outcome data were retrospectively collected. Multivariate Cox proportional-hazards analysis was performed to identify independent determinants of in-hospital survival. Coronary angiography was performed in 66 patients (71%). Forty-eight patients underwent emergency coronary angiography; in the remaining 18 patients, mean time from OHCA to coronary angiography was 13 ± 10 days. In patients referred to emergency coronary angiography, successful emergency PCI of a culprit coronary lesion was performed in 25 patients (52%). In-hospital survival rate was 54%. At multivariate analysis, emergency coronary angiography (hazard ratio 2.32, 95% confidence interval 1.23 to 4.38, p = 0.009) and successful emergency PCI (hazard ratio 2.54, 95% confidence interval 1.35 to 4.8, p = 0.004) were independently related to in-hospital survival in the overall study population; delay in performing coronary angiography (hazard ratio 0.95, 95% confidence interval 0.92 to 0.99, p = 0.013) was independently related to in-hospital mortality in patients referred to coronary angiography. In conclusion, an invasive strategy characterized by emergency coronary angiography and subsequent PCI, if indicated, seems to improve in-hospital outcome of resuscitated but unconscious patients with OHCA without obvious extracardiac cause.