Abstract 335: The Impact of Early Coronary Angiography on Outcomes in Out-of-hospital Cardiac Arrest: The Singapore Experience

Abstract

Background and Aim: The benefit of early coronary angiography (CAG) and revascularization in resuscitated out-of-hospital cardiac arrest (OHCA) is unclear. We evaluated the association between early CAG and clinical outcomes in these patients. Methods: Data on all resuscitated adult OHCA cases of cardiac etiology between 2011-2015 were extracted from the prospective Singapore Pan-Asian Resuscitation Outcomes Study and linked with data from the national database of cardiac procedures. The 30-day survival and neurological outcomes (good outcome defined as Cerebral Performance Category [CPC] 1 or 2) were compared between patients undergoing early CAG (within 1-calender day) and patients not undergoing early CAG. Inverse probability weighted estimator was used to adjust for propensity to perform early CAG and PCI. Results: Of 976 consecutive patients who survived to admission (mean age 64±13, 73.7% males), 401 (41.1%) patients underwent CAG and obstructive coronary artery disease (CAD) was present in 352 (87.8%), of whom 284 (70.8%) underwent revascularization. Patients who underwent early CAG (n=337[34.5%]) were significantly different compared to those who underwent delayed or no CAG (n=639[65.5%]) (Table 1). Early CAG and PCI patients had improved survival and better neurological outcomes (adjusted odds ratio [AOR] 3.806 [95% CI 1.675 - 8.648] and AOR 3.075 [95% CI 1.119 - 8.451]), compared to those without. The odds of survival decreased with epinephrine administration (AOR 0.357 [95% CI 0.199 - 0.640]), but increased with an initial shockable rhythm (AOR 6.587 [95% CI 3.659 - 11.861]). The rates of bleeding (2% vs 0%, p=0.300) and stroke (1.6% vs 1.9%, p=0.880) were not increased with early intervention. Conclusion: Early CAG and PCI after OHCA were associated with improved clinical outcomes after OHCA without increasing complications. Further studies are required to identify the characteristics of patients who would benefit most from this invasive strategy.