Abstract
BackgroundThe effect of immediate coronary angiography and percutaneous coronary intervention (PCI) in patients who are successfully resuscitated after cardiac arrest in the absence of ST-segment elevation myocardial infarction (STEMI) on left ventricular function is currently unknown. MethodsThis prespecified sub-study of a multicentre trial evaluated 552 patients, successfully resuscitated from out-of-hospital cardiac arrest without signs of STEMI. Patients were randomized to either undergo immediate coronary angiography or delayed coronary angiography, after neurologic recovery. All patients underwent PCI if indicated. The main outcomes of this analysis were left ventricular ejection fraction and end-diastolic and systolic volumes assessed by cardiac magnetic resonance imaging or echocardiography. ResultsData on left ventricular function was available for 397 patients. The mean (± standard deviation) left ventricular ejection fraction was 45.2% (±12.8) in the immediate angiography group and 48.4% (±13.2) in the delayed angiography group (mean difference: −3.19; 95% confidence interval [CI], −6.75 to 0.37). Median left ventricular end-diastolic volume was 177 ml in the immediate angiography group compared to 169 ml in the delayed angiography group (ratio of geometric means: 1.06; 95% CI, 0.95–1.19). In addition, mean left ventricular end-systolic volume was 90 ml in the immediate angiography group compared to 78 ml in the delayed angiography group (ratio of geometric means: 1.13; 95% CI 0.97–1.32). ConclusionIn patients successfully resuscitated after out-of-hospital cardiac arrest and without signs of STEMI, immediate coronary angiography was not found to improve left ventricular dimensions or function compared with a delayed angiography strategy.Clinical Trial Registration: Netherlands Trial Register number, NTR4973
Highlights
Out-of-hospital cardiac arrest is a leading cause of mortality and morbidity in Europe and the United States
In addition 141 patients were excluded because imaging was not available or assessable, leaving 397 patients (73.8%) in which left ventricular function and dimensions could be assessed; 202 of these patients had been assigned to the immediate angiography group and 195 to the delayed angiography group
We found no significant difference in left ventricular ejection fraction between the immediate and delayed groups in the analysis reported here
Summary
Studies have reported coronary artery disease in up to 70% of patients who underwent immediate coronary angiography after out-of-hospital cardiac arrest.[2] If myocardial infarction is the cause of the arrest, immediate coronary angiography and percutaneous coronary intervention (PCI) might salvage myocardium and prevent the loss of cardiac function and by doing so, improve outcome. The effect of immediate coronary angiography and percutaneous coronary intervention (PCI) in patients who are successfully resuscitated after cardiac arrest in the absence of ST-segment elevation myocardial infarction (STEMI) on left ventricular function is currently unknown. Conclusion: In patients successfully resuscitated after out-of-hospital cardiac arrest and without signs of STEMI, immediate coronary angiography was not found to improve left ventricular dimensions or function compared with a delayed angiography strategy. Clinical Trial Registration: Netherlands Trial Register number, NTR4973 Keywords: Out of hospital cardiac arrest, Coronary angiography, Percutaneous coronary intervention, Left ventricular function
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