title: Ischemic heart disease diagnosed before sudden cardiac arrest is independently associated with improved survival.
abstract: BACKGROUND
  Sudden cardiac arrest (SCA) is a significant public health problem, and rates of survival after resuscitation remain well below 10%. While several resuscitation-related factors are consistently associated with survival from SCA, the impact of specific comorbid conditions has not been assessed.
  
  
  RESULTS
  The Oregon Sudden Unexpected Study is an ongoing, multisource, community-based study in Portland, Oregon. Patients with SCA who underwent attempted resuscitation between 2002 and 2012 were included in this analysis if there were both arrest and prearrest medical records available. Information from the emergency medical services system, medical examiner, public health division, hospitals, and clinics was used to adjudicate SCA, evaluate comorbidities, and identify medical treatments. Univariate and multivariate analyses were performed to investigate the influence of prearrest comorbidities on survival to hospital discharge. Among 1466 included patients, established resuscitation-related predictors (Utstein factors) were associated with survival, consistent with prior reports. When a panel of prearrest comorbidities was evaluated along with Utstein factors, recognized coronary artery disease was significantly associated and predicted higher odds of survival (unadjusted odds ratio 1.5, P<0.001; adjusted odds ratio 1.5, P=0.02). In multivariable logistic models, prearrest coronary artery disease modified the survival effects of bystander cardiopulmonary resuscitation, but did not modify other Utstein factors.
  
  
  CONCLUSIONS
  An established diagnosis of coronary artery disease was associated with 50% higher odds of survival from resuscitated SCA after adjustment for all arrest-related predictors. These findings raise novel potential mechanistic insights into survival after SCA, while highlighting the importance of early recognition and treatment of coronary artery disease.
authors.affiliation: Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR (E.C.S.).
authors.forename: Eric C
authors.initials: EC
authors.lastname: Stecker
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.T., K.R., A.U.E., R.M., H.C., S.S.C.).
authors.forename: Carmen
authors.initials: C
authors.lastname: Teodorescu
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.T., K.R., A.U.E., R.M., H.C., S.S.C.).
authors.forename: Kyndaron
authors.initials: K
authors.lastname: Reinier
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.T., K.R., A.U.E., R.M., H.C., S.S.C.).
authors.forename: Audrey
authors.initials: A
authors.lastname: Uy-Evanado
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.T., K.R., A.U.E., R.M., H.C., S.S.C.).
authors.forename: Ronald
authors.initials: R
authors.lastname: Mariani
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.T., K.R., A.U.E., R.M., H.C., S.S.C.).
authors.forename: Harpriya
authors.initials: H
authors.lastname: Chugh
authors.affiliation: Department of Pathology, Oregon Health and Science University, Portland, OR (K.G.).
authors.forename: Karen
authors.initials: K
authors.lastname: Gunson
authors.affiliation: Department of Emergency Medicine, Oregon Health and Science University, Portland, OR (J.J.).
authors.forename: Jonathan
authors.initials: J
authors.lastname: Jui
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.T., K.R., A.U.E., R.M., H.C., S.S.C.).
authors.forename: Sumeet S
authors.initials: SS
authors.lastname: Chugh
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000401:mortality*; D016017:Odds Ratio; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis
keywords: atherosclerosis; heart arrest; myocardial infarction; sudden death