Long-term survival after cardiac arrest in patients undergoing emergent coronary angiography

Abstract

AimTo determine long-term survival of patients after cardiac arrest undergoing emergent coronary angiography and therapeutic hypothermia. MethodsWe analysed data from patients treated within the regional STEMI Network from January 2015 to December 2020. The primary endpoint was all-cause mortality at median follow-up. Secondary endpoints were periprocedural complications (arrhythmias, pulmonary edema, cardiogenic shock, mechanical complication, stent thrombosis, reinfarction, bleeding) and 6-month all-cause death. A landmark analysis was performed, studying two time periods; 0–6 months and beyond 6 months. ResultsFrom a total of 24,125 patients in the regional STEMI network, 494 patients who suffered from cardiac arrest were included and divided into two groups: treated with (n = 119) and without therapeutic hypothermia (n = 375). At median follow−up (16.0 [0.2–33.3] months), there was no difference in the adjusted mortality rate between groups (51.3 % with hypothermia vs 48.0 % without hypothermia; HRadj1.08 95%CI [0.77–1.53]; p = 0.659). There was a higher frequency of bleeding in the hypothermia group (6.7 % vs 1.1 %; ORadj 7.99 95%CI [2.05–31.2]; p = 0.002), without difference for the rest of periprocedural complications. At 6-month follow−up, adjusted all-cause mortality rate was similar between groups (46.2 % with hypothermia vs 44.5 % without hypothermia; HRadj1.02 95%CI [0.71–1.47]; p = 0.900). Also, no differences were observed in the adjusted mortality rate between 6 months and median follow−up (9.4 % with hypothermia vs 6.3 % without hypothermia; HRadj2.02 95%CI [0.69–5.92]; p = 0.200). ConclusionsIn a large cohort of patients with cardiac arrest within a regional STEMI network, those treated with therapeutic hypothermia did not improve long−term survival compared to those without hypothermia.