110 Incomplete Revascularization Is Associated With Adverse Outcomes in Cardiac Arrest Survivors: A Retrospective Multicenter Cohort Study

Abstract

Sudden cardiac arrest is a devastating clinical challenge. Cardiovascular disease accounts for most causes of sudden cardiac arrest and emergent coronary angiography (CAG) after return of spontaneous circulation (ROSC) is recommended when cardiogenic arrest is impressed. Incomplete revascularization had been reported to be associated with an increased risk for major adverse cardiovascular events in patients underwent non-cardiac surgery. However, the impact of incomplete revascularization on outcomes in successfully resuscitated patients with cardiogenic arrest remains unanswered. The objective of the study is to investigate the relationship between the extent of incomplete revascularization of coronary artery stenosis and outcomes (survival, neurological outcome) in cardiac arrest survivors. A total of 266 adult, non-traumatic cardiac arrest survivors who underwent emergent CAG in 3 hospitals were enrolled from January 2011 to September 2017. The following variables were collected and analyzed: baseline characteristics, pre-existing comorbidity, events during cardiopulmonary resuscitation, CAG findings, PCI results, survival to discharge or not, and neurological outcome. The stenosis extent of individual coronary artery greater than 70% was defined as severe stenosis. Incomplete revascularization was defined as a residual stenosis of more than 70% in any of major 3 coronary arteries on the basis of operator visual estimate. One-hundred ninety-three (72.6%) patients had at least 1-vessel severe stenosis and 147 patients (55.3%) received PCI revascularization. Among 167 patients who survived to hospital discharge (the survival group), 101 patients (60%) received PCI and 40 patients (24%) had at least 1 vessel with incomplete revascularization. In contrast, among 99 patients who failed to survive to hospital discharge (the non-survival group), 46 patients (46%) received PCI and 74 patients (55.3%) had at least 1 vessel with incomplete revascularization (PCI: p=0.02; incomplete revascularization: p<0.001). The number of vessels with incomplete revascularization was significantly greater in the non-survival group than in the survival group (1.3±1.0 v.s. 0.3±0.7, p<0.001). The patients with increased number of incompletely revascularized vessel were associated with a higher risk of in-hospital mortality (1-vessel: adjusted OR 6.45, 95% CI 2.91-14.26, p<0.001; 2-vessel: adjusted OR 14.44, 95% CI 5.57-33.43, p<0.001; 3-vessel: adjusted OR 15.44, 95% CI 3.94-60.53, p<0.001). There were 137 patients discharged with favorable neurological outcome (CPC=1∼2, good CPC group) and 129 patients with unfavorable neurological outcome (CPC=3∼5, poor CPC group). The poor CPC group had more incompletely revascularized vessels than the good CPC group (1.1±1.0 v.s. 0.4±0.7, p<0.001). The increase of vessels with incomplete revascularization was correlated with unfavorable neurological outcome (1-vessel: adjusted OR 3.44, 95% CI 1.72-6.91, p<0.001; 2-vessel: adjusted OR 5.28, 95% CI 1.60-17.40, p<0.001; 3-vessel: adjusted OR 6.26, 95% CI 2.57-15.29, p=0.006). The increased vessel number with incomplete revascularization was associated with higher risk for in-hospital mortality and unfavorable neurological outcome in successfully resuscitated patients with cardiogenic arrest.