Comparison of Neurological Outcome Between the Primary Percutaneous Coronary Intervention-First and Targeted Temperature Management-First Strategies in Out-of-Hospital Cardiac Arrest Patients: J-PULSE-Hypo Registry

Abstract

Target temperature management (TTM) improves neurological outcome in out-of-hospital cardiac arrest (OHCA) patients. TTM should be performed for OHCA patients as soon as possible. On the other hand, we also need to perform emergency coronary angiography and primary percutaneous coronary intervention (PCI) against ongoing myocardial ischemia for the patient after cardiac arrest of cardiac etiology. However, there have been few studies showing which therapy should be done first. We evaluate the priority of TTM or PCI after return of spontaneous circulation (ROSC) in OHCA patients using the data of the J-PULSE-Hypo Registry. This registry consisted of 14 institutes and retrospectively collected the patient after cardiac arrest to study the effect of TTM. These patients were divided into the PCI-first group and the TTM-first group to compare neurological outcomes. A favorable outcome was defined as a cerebral performance category (CPC) of 1–2. A total of 195 patients after cardiac arrest of cardiac etiology were enrolled in this present study. All patients underwent both PCI and TTM. There were no significant differences between the PCI-first group (n = 95) and the TTM-first group (n = 100) in the clinical characteristics. The PCI-first group had a longer median interval from collapse to achieve target core temperature (PCI-first, 330 [203–467] min vs. TTM-first, 179 [80–295] min; P < 0.01) than the TTM-first group. There were no significant differences in the rate of favorable outcome at 30 days (PCI-first, 54% vs. TTM-first, 50%; P = 0.67) between the two groups. The present multicenter registry study indicates that the timing of PCI did not significantly affect neurological outcome and survival in OHCA patients although PCI-first strategy delayed the induction of TTM.