Abstract
ObjectiveCoronary angiography (CAG) for survivors of out-of-hospital cardiac arrest (OHCA) enables early identification of coronary artery disease and revascularization, which might improve clinical outcome. However, little is known for the role of CAG in patients with initial non-shockable cardiac rhythm.MethodsWe investigated clinical outcomes of successfully resuscitated 670 adult OHCA patients who were transferred to 27 hospitals in Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance (CAPTURES), a Korean nationwide multicenter registry. The primary outcome was 30-day survival with good neurological outcome. Propensity score matching and inverse probability of treatment weighting analyses were performed to account for indication bias.ResultsA total of 401 (60%) patients showed initial non-shockable rhythm. CAG was performed only in 13% of patients with non-shockable rhythm (53 out of 401 patients), whereas more than half of patients with shockable rhythm (149 out of 269 patients, 55%). Clinical outcome of patients who underwent CAG was superior to patients without CAG in both non-shockable (hazard ratio (HR) = 3.6, 95% confidence interval (CI) = 2.5–5.2) and shockable rhythm (HR = 3.7, 95% CI = 2.5–5.4, p < 0.001, all). Further analysis after propensity score matching or inverse probability of treatment weighting showed consistent findings (HR ranged from 2.0 to 3.2, p < 0.001, all).ConclusionsPerforming CAG was related to better survival with good neurological outcome of OHCA patients with initial non-shockable rhythms as well as shockable rhythms.
Highlights
Out-of-hospital cardiac arrest (OHCA) is a major public health burden and associated with high morbidity and mortality rates worldwide [1]
We investigated clinical outcomes of successfully resuscitated 670 adult OHCA patients who were transferred to 27 hospitals in Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance (CAPTURES), a Korean nationwide multicenter registry
Clinical outcome of patients who underwent coronary angiography (CAG) was superior to patients without CAG in both non-shockable (hazard ratio (HR) = 3.6, 95% confidence interval (CI) = 2.5–5.2) and shockable rhythm (HR = 3.7, 95% CI = 2.5–5.4, p < 0.001, all)
Summary
Out-of-hospital cardiac arrest (OHCA) is a major public health burden and associated with high morbidity and mortality rates worldwide [1]. Improved survival among OHCA survivor who underwent coronary angiography (CAG) can be anticipated because CAG enables immediate diagnosis and appropriate treatment including revascularization [4, 5]. The clinical benefit of CAG has been studied mostly for adult OHCA patients with initial shockable rhythm such as ventricular tachyarrhythmia [4, 5]. It is not well known whether performing CAG has clinical benefit in OHCA patient with initial non-shockable rhythms including pulseless electrical activity (PEA) and asystole. The aim of this study was to assess the association between CAG and clinical outcomes in adult non-shockable OHCA from Korean nationwide multicenter OHCA registry. Propensity score matching and inverse probability of treatment weighting analyses were applied to minimize indication bias
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