Abstract 25: Early Coronary Angiography and Survival After Out-Of-Hospital Cardiac Arrest

Abstract

Background: Ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) are common rhythms seen in out-of-hospital cardiac arrest (OHCA). Although acute myocardial infarction is a frequent cause of VF and pulseless VT, it is unknown whether a strategy of early coronary angiography is associated with improved survival in patients with OHCA. Methods: Using data from the Cardiac Arrest Registry to Enhance Survival (CARES), we identified 1810 adult patients who had an OHCA due to VF, pulseless VT, or an unknown but shockable rhythm and were successfully resuscitated and admitted to a hospital. Using a matched propensity score analysis, we examined the association between a strategy of early coronary angiography within the first day of cardiac arrest and survival to discharge. Results: Early coronary angiography was performed in 874 (48.3%) patients, of whom 523 (59.8%) received coronary stents. Compared to those without early angiography, patients undergoing early coronary angiography were younger (59.9 vs. 62.5 years); more likely to be men (77.9% vs. 64.5%), have a witnessed arrest (86.3% vs. 76.7%), have a diagnosis of ST-elevation myocardial infarction (STEMI) (68.5% vs. 20.3%); and less likely to have known cardiovascular disease (37.3% vs. 54.3%), diabetes (15.4% vs. 26.6%), and renal disease (3.7% vs. 8.3%) (P <0.01 for all comparisons). A total of 565 patients without early angiography were successfully matched to 565 patients with early coronary angiography (c-statistic of 0.77). A strategy of early coronary angiography was associated with higher rates of in-hospital survival (adjusted OR: 1.22, [1.02- 1.45], P=0.025). There were no differences in favorable neurological outcome between the two groups (adjusted OR: 1.10, [0.98-1.23], P=0.12). Conclusion: Among patients with an OHCA due to VF or pulseless VT who were successfully resuscitated and admitted to a hospital, a strategy of early coronary angiography was associated with better survival, which was not compromised by worse neurological outcomes. Given that many patients with an OHCA due to VF or pulseless VT do not currently undergo early coronary angiography, randomized trials are needed to confirm whether a strategy of early coronary angiography can improve outcomes in patients with OHCA.