title: Immediate percutaneous coronary intervention is associated with better survival after out-of-hospital cardiac arrest: insights from the PROCAT (Parisian Region Out of hospital Cardiac ArresT) registry.
abstract: BACKGROUND
  Acute coronary occlusion is the leading cause of cardiac arrest. Because of limited data, the indications and timing of coronary angiography and angioplasty in patients with out-of-hospital cardiac arrest are controversial. Using data from the Parisian Region Out of hospital Cardiac ArresT prospective registry, we performed an analysis to assess the effect of an invasive strategy on hospital survival.
  
  
  RESULTS
  Between January 2003 and December 2008, 714 patients with out-of-hospital cardiac arrest were referred to a tertiary center in Paris, France. In 435 patients with no obvious extracardiac cause of arrest, an immediate coronary angiogram was performed at admission followed, if indicated, by coronary angioplasty. At least 1 significant coronary artery lesion was found in 304 (70%) patients, in 128 (96%) of 134 patients with ST-segment elevation on the ECG performed after the return of spontaneous circulation, and in 176 (58%) of 301 patients without ST-segment elevation. The hospital survival rate was 40%. Multivariable analysis showed successful coronary angioplasty to be an independent predictive factor of survival, regardless of the postresuscitation ECG pattern (odds ratio, 2.06; 95% CI, 1.16 to 3.66).
  
  
  CONCLUSIONS
  Successful immediate coronary angioplasty is associated with improved hospital survival in patients with or without ST-segment elevation. Therefore, our findings support the use of immediate coronary angiography in patients with out-of-hospital cardiac arrest with no obvious noncardiac cause of arrest regardless of the ECG pattern.
authors.affiliation: INSERM U970, Paris Cardiovascular Research Center, European Georges Pompidou Hospital, Paris, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Dumas
authors.forename: Alain
authors.initials: A
authors.lastname: Cariou
authors.forename: Stéphane
authors.initials: S
authors.lastname: Manzo-Silberman
authors.forename: David
authors.initials: D
authors.lastname: Grimaldi
authors.forename: Benoît
authors.initials: B
authors.lastname: Vivien
authors.forename: Julien
authors.initials: J
authors.lastname: Rosencher
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Empana
authors.forename: Pierre
authors.initials: P
authors.lastname: Carli
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Mira
authors.forename: Xavier
authors.initials: X
authors.lastname: Jouven
authors.forename: Christian
authors.initials: C
authors.lastname: Spaulding
mesh_terms: D000368:Aged; D017073:Atherectomy; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D005602:France; D006323:Heart Arrest / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D012042:Registries; D016019:Survival Analysis