336 Outcome after immediate invasive strategy in out-of-hospital cardiac arrest

Abstract

According to the most recent guidelines, patients resuscitated from a cardiac arrest due to an acute coronary syndrome (ACS) should undergo an immediate coronary angiography with a subsequent percutaneous coronary intervention (PCI) if indicated. However, the outcome of this strategy and the value of the ECG in this setting are controversial. The aim of our study is to describe the results of such a strategy and to analyze the value of the ECG in a large cohort of patients resuscitated from an out-of-hospital cardiac arrest (OHCA). A coronary angiogram was performed in all survivors of an OHCA referred to a tertiary center if there was no obvious non-cardiac cause of arrest. ECG changes noted on the electrocardiogram recorded after the return of spontaneous circulation were classified in 3 patterns (Group 1: ST segment elevation, Group 2: ST segment depression, conduction anomalies or negative T waves, Group 3: non-specific changes or normal). 669 OHCA patients were admitted between January 2003 and August 2008. A coronary angiogram was performed in 372 (56%) ST segment elevation was noted in 112 patients (30%), ST depression or negative T waves in 183 (49%) and non-specific changes or normal ECG in 77 (21%). PCI was performed in 156 patients (42%). PCI was more frequently performed in patients with ST elevation (90/112, 80%) than in the other groups (Group 2: 52/183, 28% Group 3: 14/77, 18%, p<0.0001). Overall 153/372 patients (41%) survived during their hospital stay. The survival rates were respectively of 57/112 patients (51%) in Group 1, 75/183 patients (41%) in Group 2 and 21/77 patients (27%) in Group 3 (p<0.005). Our results suggest that an immediate coronary angiography with subsequent PCI is associated with a low mortality rate, particularly in patients with ST segment elevation. Further analyses will investigate the exact impact of such a strategy in all subsets of OHCA patients.