title: Impact of emergency coronary angiography on in-hospital outcome of unconscious survivors after out-of-hospital cardiac arrest.
abstract: Acute coronary thrombotic occlusion is the most common trigger of cardiac arrest. The aim of the present study was to assess the impact of an invasive strategy characterized by emergency coronary angiography and subsequent percutaneous coronary intervention (PCI), if indicated, on in-hospital survival of resuscitated patients with out-of-hospital cardiac arrest (OHCA) and no obvious extracardiac cause who do not regain consciousness soon after recovery of spontaneous circulation. Ninety-three consecutive patients (67 ± 12 years old, 76% men) were included in the study. Clinical characteristics and coronary angiographic and in-hospital outcome data were retrospectively collected. Multivariate Cox proportional-hazards analysis was performed to identify independent determinants of in-hospital survival. Coronary angiography was performed in 66 patients (71%). Forty-eight patients underwent emergency coronary angiography; in the remaining 18 patients, mean time from OHCA to coronary angiography was 13 ± 10 days. In patients referred to emergency coronary angiography, successful emergency PCI of a culprit coronary lesion was performed in 25 patients (52%). In-hospital survival rate was 54%. At multivariate analysis, emergency coronary angiography (hazard ratio 2.32, 95% confidence interval 1.23 to 4.38, p = 0.009) and successful emergency PCI (hazard ratio 2.54, 95% confidence interval 1.35 to 4.8, p = 0.004) were independently related to in-hospital survival in the overall study population; delay in performing coronary angiography (hazard ratio 0.95, 95% confidence interval 0.92 to 0.99, p = 0.013) was independently related to in-hospital mortality in patients referred to coronary angiography. In conclusion, an invasive strategy characterized by emergency coronary angiography and subsequent PCI, if indicated, seems to improve in-hospital outcome of resuscitated but unconscious patients with OHCA without obvious extracardiac cause.
authors.affiliation: Division of Cardiology, University Hospital, Santa Maria della Misericordia, Udine, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Zanuttini
authors.forename: Ilaria
authors.initials: I
authors.lastname: Armellini
authors.forename: Gaetano
authors.initials: G
authors.lastname: Nucifora
authors.forename: Elio
authors.initials: E
authors.lastname: Carchietti
authors.forename: Giulio
authors.initials: G
authors.lastname: Trillò
authors.forename: Leonardo
authors.initials: L
authors.lastname: Spedicato
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Bernardi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Proclemer
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000401:mortality; D017023:Coronary Angiography; D004636:Emergency Service, Hospital; D004638:Emergency Treatment; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D015996:Survival Rate; D014474:Unconsciousness