Abstract 14379: Variation of Percutaneous Coronary Intervention in Patients Resuscitated From Out-of-Hospital Cardiac Arrest- A Statewide Evaluation

Abstract

Our primary objective is to describe the use of percutaneous coronary intervention (PCI) in patients resuscitated from OHCA using a probabilistic linked statewide EMS and hospital dataset. A secondary objective was to compare variations of care rendered by hospitals across Michigan. We performed a retrospective study to describe PCI use in Adult (>18 years) OHCA patients resuscitated and transported to Michigan hospitals July 1, 2010 to June 30, 2013. We linked two databases , the Michigan EMS Information System (MI_EMSIS) and the Michigan Inpatient Database (MIDB), using a previously validated methodology to create our dataset. Inter-hospital transfers, duplicate cases, and cases with missing arrest rhythms were excluded. This dataset was queried for patient demographics, EMS cardiac arrest variables, provision of PCI, clinical characteristics(VF, cardiogenic shock (Cshock)), hospital diagnosis (AMI) and outcome. Rates of procedure are reported in aggregate and stratified by clinical characteristics, and, to assess the impact of geography on emergency care by the eight Michigan Emergency Care regions. During the study period there were 2,855 matched EMS and MHA records, of which 32.1% survived to hospital discharge. PCI was almost exclusively performed in patients with AMI (38.7% vs 1.6%, (OR=39.0, 95% CI 26.7, 56.8). Clinical factors associated with PCI included initial VF (21.6% vs 9.5%, OR=2.6, 95% CI (2.1,3.3) or Cshock (28.6% vs 8.7%, OR=4.2, 95% CI 3.3, 5.3) Rates of PCI statewide and by region are reported in the table and demonstrate significant variation by region. Conclusion: We identified relatively low rates of PCI for post arrest patients, which was performed primarily for patients with final diagnosis AMI. Patients with initial VF, or cardiogenic shock were more likely to receive PCI. While geographic factors impact post cardiac arrest care, we observe that a minority of post arrest patients in Michigan receive aggressive reperfusion care.