Immediate Percutaneous Coronary Intervention Is Associated With Better Survival After Out-of-Hospital Cardiac Arrest

TLDR

Acute coronary occlusion is the leading cause of cardiac arrest, yet the indications and timing of coronary angiography and angioplasty in out‑of‑hospital cardiac arrest remain controversial due to limited data. The study assessed the effect of an invasive strategy on hospital survival in out‑of‑hospital cardiac arrest patients using the Parisian Region Out‑of‑Hospital Cardiac Arrest prospective registry. The authors analyzed 714 consecutive out‑of‑hospital cardiac arrest patients, performing immediate coronary angiography and, when indicated, angioplasty in 435 patients without an obvious extracardiac cause. Successful immediate coronary angioplasty was independently associated with improved hospital survival (40% overall, odds ratio 2.06) in patients with or without ST‑segment elevation, supporting its use regardless of ECG pattern.

Abstract

Background— Acute coronary occlusion is the leading cause of cardiac arrest. Because of limited data, the indications and timing of coronary angiography and angioplasty in patients with out-of-hospital cardiac arrest are controversial. Using data from the Parisian Region Out of hospital Cardiac ArresT prospective registry, we performed an analysis to assess the effect of an invasive strategy on hospital survival. Methods and Results— Between January 2003 and December 2008, 714 patients with out-of-hospital cardiac arrest were referred to a tertiary center in Paris, France. In 435 patients with no obvious extracardiac cause of arrest, an immediate coronary angiogram was performed at admission followed, if indicated, by coronary angioplasty. At least 1 significant coronary artery lesion was found in 304 (70%) patients, in 128 (96%) of 134 patients with ST-segment elevation on the ECG performed after the return of spontaneous circulation, and in 176 (58%) of 301 patients without ST-segment elevation. The hospital survival rate was 40%. Multivariable analysis showed successful coronary angioplasty to be an independent predictive factor of survival, regardless of the postresuscitation ECG pattern (odds ratio, 2.06; 95% CI, 1.16 to 3.66). Conclusions— Successful immediate coronary angioplasty is associated with improved hospital survival in patients with or without ST-segment elevation. Therefore, our findings support the use of immediate coronary angiography in patients with out-of-hospital cardiac arrest with no obvious noncardiac cause of arrest regardless of the ECG pattern.