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.
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Article Info
Publication History
Published online: September 12, 2012
Accepted:
August 8,
2012
Received in revised form:
August 8,
2012
Received:
June 20,
2012
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
