Early cardiac catheterization is associated with improved survival in comatose survivors of cardiac arrest without STEMI.
OBJECTIVE
To determine if early cardiac catheterization (CC) is associated with improved survival in comatose patients who are resuscitated after cardiac arrest when electrocardiographic evidence of ST-elevation myocardial infarction (STEMI) is absent.


METHODS
We conducted a retrospective observational study of a prospective cohort of 754 consecutive comatose patients treated with therapeutic hypothermia (TH) following cardiac arrest.


RESULTS
A total of 269 (35.7%) patients had cardiac arrest due to a ventricular arrhythmia without STEMI and were treated with TH. Of these, 122 (45.4%) received CC while comatose (early CC). Acute coronary occlusion was discovered in 26.6% of patients treated with early CC compared to 29.3% of patients treated with late CC (p=0.381). Patients treated with early CC were more likely to survive to hospital discharge compared to those not treated with CC (65.6% vs. 48.6%; p=0.017). In a multivariate regression model that included study site, age, bystander CPR, shock on admission, comorbid medical conditions, witnessed arrest, and time to return of spontaneous circulation, early CC was independently associated with a significant reduction in the risk of death (OR 0.35, 95% CI 0.18-0.70, p=0.003).


CONCLUSIONS
In comatose survivors of cardiac arrest without STEMI who are treated with TH, early CC is associated with significantly decreased mortality. The incidence of acute coronary occlusion is high, even when STEMI is not present on the postresuscitation electrocardiogram.
Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, United States. Electronic address: ryan.hollenbeck@vanderbilt.edu.
Ryan D
RD
Hollenbeck
Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.
John A
JA
McPherson
Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN, United States.
Michael R
MR
Mooney
Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN, United States.
Barbara T
BT
Unger
Division of Cardiovascular Medicine, Lehigh Valley Hospital and Health Network, Allentown, PA, United States.
Nainesh C
NC
Patel
Department of Cardiology, Ochsner Medical Center, New Orleans, LA, United States.
Paul W
PW
McMullan
Department of Epidemiology and Biostatistics, University of Arizona College of Public Health, Tucson, AZ, United States.
Chiu-Hsieh
CH
Hsu
Department of Critical Care Services and Neuroscience Institute, Maine Medical Center, Portland, ME, United States.
David B
DB
Seder
Division of Cardiovascular Medicine, University of Arizona Medical Center, Tucson, AZ, United States.
Karl B
KB
Kern
D000368:Aged; D006328:Cardiac Catheterization; D003128:Coma / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D061345:Early Medical Intervention; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D012189:Retrospective Studies; D015996:Survival Rate; D017741:Survivors
ACS; CC; CPC; Cardiac arrest; Cardiac catheterization; ECG; INTCAR; International Cardiac Arrest Registry; PCI; ROSC; ST-elevation myocardial infarction; STEMI; TH; Therapeutic hypothermia; acute coronary syndromes; cardiac catheterization; cerebral performance category; electrocardiogram; percutaneous coronary intervention; return of spontaneous circulation; therapeutic hypothermia