title: Favourable 5-year postdischarge survival of comatose patients resuscitated from out-of-hospital cardiac arrest, managed with immediate coronary angiogram on admission.
abstract: OBJECTIVE
  On-admission coronary angiogram (CA) with angioplasty (percutaneous coronary intervention, PCI) may improve survival in patients resuscitated from out-of-hospital cardiac arrest (OHCA), but long-term survival data are scarce. We assessed long-term survival in OHCA patients managed with on-admission CA and PCI if indicated and compared survival rates in patients with/without acute coronary syndrome (ACS).
  
  
  METHODS
  Retrospective single-centre study including patients aged ≥18 years resuscitated from an OHCA without noncardiac cause, with sustained return of spontaneous circulation, undergoing on-admission CA with PCI if indicated. ACS was diagnosed angiographically. Survival was recorded at hospital discharge and at 5-year follow up. Survival probability was estimated by Kaplan-Meier survival curves.
  
  
  RESULTS
  A total of 300 comatose patients aged 56 years (IQR 48-67 years) were included, 36% with ST-segment elevation. All had on-admission CA; 31% had ACS. PCI was attempted in 91% of ACS patients and was successful in 93%. Hypothermia was performed in 84%. Survival to discharge was 32.3%. After discharge, 5-year survival was 81.7 ± 5.4%. Survival from admission to 5 years was 26.2 ± 2.8%. ACS patients had better survival to discharge (40.8%) compared with non-ACS patients (28.5%, p=0.047). After discharge, 5-year survival was 92.2 ± 5.4% for patients with ACS and 73.4 ± 8.6% without ACS (hazard ratio, HR, 2.7, 95% CI 0.8-8.9, p=0.1). Survival from admission to 5 years was 37.4 ± 5.2% for ACS patients, 20.7 ± 3.0%, for non-ACS patients (HR 1.5, 95% CI 1.12-2.0, p=0.0067).
  
  
  CONCLUSIONS
  OHCA patients undergoing on-admission CA had a very favourable postdischarge survival. Patients with OHCA due to ACS had better survival to discharge at 5-year follow up than patients with OHCA due to other causes.
authors.affiliation: Lariboisière Hospital, Paris, France.
authors.forename: Georgios
authors.initials: G
authors.lastname: Sideris
authors.forename: Sebastian
authors.initials: S
authors.lastname: Voicu
authors.forename: Demetris
authors.initials: D
authors.lastname: Yannopoulos
authors.forename: Jean-Guillaume
authors.initials: JG
authors.lastname: Dillinger
authors.forename: Julien
authors.initials: J
authors.lastname: Adjedj
authors.forename: Nicolas
authors.initials: N
authors.lastname: Deye
authors.forename: Papa
authors.initials: P
authors.lastname: Gueye
authors.forename: Stéphane
authors.initials: S
authors.lastname: Manzo-Silberman
authors.forename: Isabelle
authors.initials: I
authors.lastname: Malissin
authors.forename: Damien
authors.initials: D
authors.lastname: Logeart
authors.forename: Nikos
authors.initials: N
authors.lastname: Magkoutis
authors.forename: Dragos D
authors.initials: DD
authors.lastname: Capan
authors.forename: Siham
authors.initials: S
authors.lastname: Makhloufi
authors.forename: Bruno
authors.initials: B
authors.lastname: Megarbane
authors.forename: Benoit
authors.initials: B
authors.lastname: Vivien
authors.forename: Alain
authors.initials: A
authors.lastname: Cohen-Solal
authors.forename: Didier
authors.initials: D
authors.lastname: Payen
authors.forename: Frédéric J
authors.initials: FJ
authors.lastname: Baud
authors.forename: Patrick
authors.initials: P
authors.lastname: Henry
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000628:therapy; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D003128:Coma / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D017023:Coronary Angiography / Q000379:methods / Q000401:mortality; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: Acute coronary syndrome; coronary angiography; heart arrest; long-term survival