Coronary artery disease
Comparison of Role of Early (Less Than Six Hours) to Later (More Than Six Hours) or No Cardiac Catheterization After Resuscitation From Out-of-Hospital Cardiac Arrest

https://doi.org/10.1016/j.amjcard.2011.09.036Get rights and content

Despite reports of patients with resuscitated sudden cardiac arrest (rSCA) receiving acute cardiac catheterization, the efficacy of this strategy is largely unknown. We hypothesized that acute cardiac catheterization of patients with rSCA would improve survival to hospital discharge. A retrospective cohort of 240 patients with out-of-hospital rSCA caused by ventricular tachycardia or fibrillation was identified from 11 institutions in Seattle, Washington from 1999 through 2002. Patients were grouped into those receiving acute catheterization within 6 hours (≤6-hour group, n = 61) and those with deferred catheterization at >6 hours or no catheterization during the index hospitalization (>6-hour group, n = 179). Attention was directed to survival to hospital discharge, neurologic status, extent of coronary artery disease, presenting electrocardiographic findings, and symptoms before arrest. Propensity-score methods were used to adjust for the likelihood of receiving acute catheterization. Survival was greater in patients who underwent acute catheterization (72% in the ≤6-hour group vs 49% in the >6-hour group, p = 0.001). Percutaneous coronary intervention was performed in 38 of 61 patients (62%) in the ≤6-hour group and 13 of 170 patients (7%) in the >6-hour group (p <0.0001). Neurologic status was similar in the 2 groups. A significantly larger percentage of patients in the acute catheterization group had symptoms before cardiac arrest and had ST-segment elevation on electrocardiogram after resuscitation. Age, bystander cardiopulmonary resuscitation, daytime presentation, history of percutaneous coronary intervention or stroke, and acute ST-segment elevation were positively associated with receiving cardiac catheterization. In conclusion, in this series of patients who sustained out-of-hospital cardiac arrest, acute catheterization (<6 hours of presentation) was associated with improved survival.

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Methods

This study included 240 consecutive patients who were resuscitated from out-of-hospital rSCA with ventricular fibrillation or tachycardia as the first identified rhythm. At successful resuscitation the patients were transported to 1 of 11 receiving hospitals, all but 1 with cardiac catheterization facilities. The incidents occurred from January 6, 1999 through December 15, 2002, a period before widespread use of therapeutic hypothermia for resuscitated ventricular fibrillation patients in

Results

Of the 240 patients, 25% underwent acute cardiac catheterization (≤6-hour group) and 75% did not (>6-hour group). In the >6-hour group, 43 underwent cardiac catheterization 6 hours after hospital admission and 136 did not undergo this procedure. Patients in the ≤6-hour group were 3 years younger and more often men, although the racial distribution was similar in the 2 groups (Table 1). With respect to medical histories, patients in the ≤6-hour group less often had previously recognized coronary

Discussion

In this series of patients who sustained out-of-hospital cardiac arrest, acute catheterization (defined as the procedure performed within the first 6 hours) was associated with improved survival in bivariate and multivariate analyses compared to the group receiving no catheterization or after 6 hours. In addition, using propensity scoring to identify patients with a higher likelihood of receiving acute catheterization identified a subpopulation of patients in whom acute catheterization was

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This work was supported by a grant from the Medic One Foundation, Seattle, Washington, and Grant RO1 HL089554 from the National Institutes of Health/National Heart, Lung, and Blood Institute, Bethesda, Maryland (Dr. Kim).

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