Journal
JOURNAL OF CLINICAL MEDICINE
Volume 10, Issue 21, Pages -Publisher
MDPI
DOI: 10.3390/jcm10215191
Keywords
coronary angiography; percutaneous coronary intervention; out-of-hospital cardiac arrest; 30-day survival; neurological outcomes
Categories
Funding
- National Medical Research Council, Clinician Scientist Awards, Singapore [NMRC/CSA/024/2010, NMRC/CSA/0049/2013]
- Ministry of Health, Health Services Research Grant, Singapore [HSRG/0021/2012]
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This study evaluated the association between early coronary angiography (CAG) and outcomes in resuscitated out-of-hospital cardiac arrest (OHCA) patients and found that early CAG with PCI was associated with better survival and neurological outcome. Further research is needed to identify the characteristics of patients who would benefit most from this invasive strategy.
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.
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