title: Combining therapeutic hypothermia and emergent coronary angiography in out-of-hospital cardiac arrest survivors: Optimal post-arrest care for the best patient.
abstract: BACKGROUND
  Aggressive post-resuscitation care, in particular combining mild therapeutic hypothermia (MTH) with early coronary angiography (CAG) and percutaneous coronary intervention (PCI), may improve prognosis after out-of-hospital cardiac arrest (OHCA).
  
  
  OBJECTIVE
  The study aims to assess the value of immediate CAG or PCI in comatose survivors after OHCA treated with MTH and their association with outcomes.
  
  
  METHODS
  Observational, prospective analysis of all comatose, resuscitated patients treated with MTH at a tertiary centre and undergoing CAG or PCI ≤6 hours after OHCA, or non-invasively managed. Primary outcomes were 30-day and 1-year survival.
  
  
  RESULTS
  From March 2004-December 2012, 141 (51%) out of 278 comatose patients after cardiac OHCA were treated with MTH (median age: 64.5 (interquartile range 55-73) years, males: 67%, first shockable rhythm: 70%, witnessed OHCA: 94%, interval OHCA-resuscitation ≤20 min: 81%). Ninety-seven patients (69%) underwent early CAG, and 45 (32%) of them PCI. Patients undergoing CAG or PCI had a more favourable risk profile than subjects non-invasively managed. PCI treated patients had more bleedings, but no stent thrombosis occurred. Thirty-day and one-year unadjusted total mortality rates were 50% and 72% for non-invasively managed patients, 26% and 38.7% for patients submitted only to CAG and 32% and 36.6% for patients treated with PCI (p=0.0435 for early death, and p<0.0001 for one-year mortality, respectively). However, a propensity-matched score analysis did not confirm the survival advantage of invasive management (p=0.093). At multivariable analysis, clinical and OHCA-related variables as well as CAG, but not PCI, were associated with outcomes.
  
  
  CONCLUSIONS
  Comatose patients cooled after OHCA and submitted to emergency CAG or PCI are a favourable outcome population that receives optimal post-arrest care.
authors.affiliation: Department of Cardiology, Maggiore Hospital, Bologna, Italy gianni.casella@alice.it.
authors.forename: Gianni
authors.initials: G
authors.lastname: Casella
authors.affiliation: Department of Cardiology, Maggiore Hospital, Bologna, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Carinci
authors.affiliation: Intensive Care Unit/118 EMS, Maggiore Hospital, Bologna, Italy.
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Cavallo
authors.affiliation: Regional Health Care Agency, Regione Emilia-Romagna, Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Guastaroba
authors.affiliation: Department of Cardiology, Maggiore Hospital, Bologna, Italy.
authors.forename: Pier C
authors.initials: PC
authors.lastname: Pavesi
authors.affiliation: Department of Cardiology, Maggiore Hospital, Bologna, Italy.
authors.forename: Maria G
authors.initials: MG
authors.lastname: Pallotti
authors.affiliation: Department of Cardiology, Maggiore Hospital, Bologna, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Sangiorgio
authors.affiliation: Department of Cardiology, Maggiore Hospital, Bologna, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Barbato
authors.affiliation: Intensive Care Unit/118 EMS, Maggiore Hospital, Bologna, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Coniglio
authors.affiliation: Intensive Care Unit/118 EMS, Maggiore Hospital, Bologna, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Iarussi
authors.affiliation: Intensive Care Unit/118 EMS, Maggiore Hospital, Bologna, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gordini
authors.affiliation: Department of Cardiology, Maggiore Hospital, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Pasquale
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000379:methods; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Cardiac arrest; coronary angiography; coronary intervention; hypothermia; outcome; survival