title: Characteristics and outcomes in patients undergoing percutaneous coronary intervention following cardiac arrest (from the NCDR).
abstract: Outcomes in patients with out-of-hospital cardiac arrest (CA) who undergo percutaneous coronary intervention (PCI) have been limited to small, mostly single-center studies. We compared patients who underwent PCI after CA included in the CathPCI Registry with those without CA. Patients with ST elevation were classified as ST-elevation myocardial infarction (STEMI); all other patients having PCI were classified as without STEMI. Patients with CA in each group were compared with the corresponding non-CA groups for baseline characteristics, angiographic findings, and outcomes. A total of 594,734 patients underwent PCI, of whom 114,768 had STEMI, including 9,375 (8.2%) had CA, and 479,966 had without STEMI, including 2,775 (0.6%) had CA. Patients with CA were similar in age to patients with non-CA, with a lower frequency of coronary disease risk factors and known coronary disease. On angiography, patients with CA were significantly more likely to have more complex lesions with worse baseline thrombolysis in myocardial infarction flow. Patients with CA were significantly more likely to have cardiogenic shock, both for patients with STEMI (51% vs 7.2%, respectively) and for patients without STEMI (38% vs 0.8%, respectively, both p<0.001). In-hospital mortality was substantially worse in patients with CA, for both patients with STEMI (24.9% vs 3.1%, respectively) and patients without STEMI (18.7% vs 0.4%, respectively). In conclusion, patients who underwent PCI after CA had more complex anatomy, more shock, and higher mortality. The substantially increased mortality in patients with CA has important implications for the development and regionalization of centers for CA.
authors: Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: ngupta@mcw.edu.
authors: Navdeep
authors: N
authors: Gupta
authors: Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virgina.
authors: Michael C
authors: MC
authors: Kontos
authors: Department of Internal Medicine, Rosalind Franklin University of Medicine and Science, Chicago, Illinois.
authors: Aditi
authors: A
authors: Gupta
authors: Duke Clinical Research Institute, Durham, North Carolina.
authors: David
authors: D
authors: Dai
authors: Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virgina.
authors: George W
authors: GW
authors: Vetrovec
authors: Duke Clinical Research Institute, Durham, North Carolina.
authors: Matthew T
authors: MT
authors: Roe
authors: Department of Internal Medicine, University of Colorado, Aurora, Colorado.
authors: John
authors: J
authors: Messenger
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology