title: Immediate Percutaneous Coronary Intervention Is Associated With Improved Short- and Long-Term Survival After Out-of-Hospital Cardiac Arrest.
abstract: BACKGROUND
  Whether to perform or not an immediate percutaneous coronary intervention (PCI) after out-of-hospital cardiac arrest is still debated. We aimed to evaluate the impact of PCI on short- and long-term survival in out-of-hospital cardiac arrest patients admitted after successful resuscitation.
  
  
  RESULTS
  Between 2000 and 2013, all nontrauma out-of-hospital cardiac arrest patients admitted in a Parisian cardiac arrest center after return of spontaneous circulation were prospectively included. The association between immediate PCI and short- and long-term mortality was analyzed using logistic regression and Cox multivariate analysis, respectively. Propensity score-matching method was used to assess the influence of PCI on short- and long-term survival. During the study period, 1722 patients (71.5% male, median age 60 [49.6, 72.2] years) were analyzed: 628 (35.6%) without coronary angiography, 615 (35.7%) with coronary angiography without PCI, and 479 (27.8%) with both. Among these groups, day 30 and year-10 survival rates were 21% and 11.9%, 35% and 29%, 43% and 38%, respectively (P<0.01 for each). PCI as compared with no coronary angiography was associated with a lower day-30 and long-term mortality (adjORcoro with PCI versus no coro 0.71, 95% confidence interval [0.54, 0.92]; P=0.02 and adjHRcoro with PCI versus no coro 0.44, 95% confidence interval [0.27, 0.71]; P<0.01, respectively). PCI remained associated with a lower risk of long-term mortality (adjHR 0.29; 95% confidence interval [0.14, 0.61]; P<0.01) in propensity score-matching analysis.
  
  
  CONCLUSIONS
  Immediate PCI after out-of-hospital cardiac arrest was associated with significant reduced risk of short- and long-term mortality. These findings should suggest physicians to consider immediate coronary angiography and PCI if indicated in these patients.
authors.affiliation: From the Medical Intensive Care Unit (G.G., W.B., F. Daviaud, F.P., J.-D.C., J.-P.M., A.C.), Emergency Department (F. Dumas), and Cardiology Department (O.V.), Cochin Hospital, Assistance Publique Hôpitaux de Paris; Emergency Medical Service, SAMU 75 (L.L.); INSERM, UMR-S970, Paris Cardiovascular Research Centre, Department of Epidemiology, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (G.G., F. Dumas, W.B., O.V., F. Daviaud, F.P., L.L., J.-D.C., C.S., J.-P.M., J.-P.E., A.C.); Sudden Death Expertise Center, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); and Cardiology Department, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris (C.S.).
authors.forename: Guillaume
authors.initials: G
authors.lastname: Geri
authors.affiliation: From the Medical Intensive Care Unit (G.G., W.B., F. Daviaud, F.P., J.-D.C., J.-P.M., A.C.), Emergency Department (F. Dumas), and Cardiology Department (O.V.), Cochin Hospital, Assistance Publique Hôpitaux de Paris; Emergency Medical Service, SAMU 75 (L.L.); INSERM, UMR-S970, Paris Cardiovascular Research Centre, Department of Epidemiology, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (G.G., F. Dumas, W.B., O.V., F. Daviaud, F.P., L.L., J.-D.C., C.S., J.-P.M., J.-P.E., A.C.); Sudden Death Expertise Center, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); and Cardiology Department, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris (C.S.).
authors.forename: Florence
authors.initials: F
authors.lastname: Dumas
authors.affiliation: From the Medical Intensive Care Unit (G.G., W.B., F. Daviaud, F.P., J.-D.C., J.-P.M., A.C.), Emergency Department (F. Dumas), and Cardiology Department (O.V.), Cochin Hospital, Assistance Publique Hôpitaux de Paris; Emergency Medical Service, SAMU 75 (L.L.); INSERM, UMR-S970, Paris Cardiovascular Research Centre, Department of Epidemiology, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (G.G., F. Dumas, W.B., O.V., F. Daviaud, F.P., L.L., J.-D.C., C.S., J.-P.M., J.-P.E., A.C.); Sudden Death Expertise Center, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); and Cardiology Department, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris (C.S.).
authors.forename: Wulfran
authors.initials: W
authors.lastname: Bougouin
authors.affiliation: From the Medical Intensive Care Unit (G.G., W.B., F. Daviaud, F.P., J.-D.C., J.-P.M., A.C.), Emergency Department (F. Dumas), and Cardiology Department (O.V.), Cochin Hospital, Assistance Publique Hôpitaux de Paris; Emergency Medical Service, SAMU 75 (L.L.); INSERM, UMR-S970, Paris Cardiovascular Research Centre, Department of Epidemiology, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (G.G., F. Dumas, W.B., O.V., F. Daviaud, F.P., L.L., J.-D.C., C.S., J.-P.M., J.-P.E., A.C.); Sudden Death Expertise Center, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); and Cardiology Department, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris (C.S.).
authors.forename: Olivier
authors.initials: O
authors.lastname: Varenne
authors.affiliation: From the Medical Intensive Care Unit (G.G., W.B., F. Daviaud, F.P., J.-D.C., J.-P.M., A.C.), Emergency Department (F. Dumas), and Cardiology Department (O.V.), Cochin Hospital, Assistance Publique Hôpitaux de Paris; Emergency Medical Service, SAMU 75 (L.L.); INSERM, UMR-S970, Paris Cardiovascular Research Centre, Department of Epidemiology, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (G.G., F. Dumas, W.B., O.V., F. Daviaud, F.P., L.L., J.-D.C., C.S., J.-P.M., J.-P.E., A.C.); Sudden Death Expertise Center, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); and Cardiology Department, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris (C.S.).
authors.forename: Fabrice
authors.initials: F
authors.lastname: Daviaud
authors.affiliation: From the Medical Intensive Care Unit (G.G., W.B., F. Daviaud, F.P., J.-D.C., J.-P.M., A.C.), Emergency Department (F. Dumas), and Cardiology Department (O.V.), Cochin Hospital, Assistance Publique Hôpitaux de Paris; Emergency Medical Service, SAMU 75 (L.L.); INSERM, UMR-S970, Paris Cardiovascular Research Centre, Department of Epidemiology, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (G.G., F. Dumas, W.B., O.V., F. Daviaud, F.P., L.L., J.-D.C., C.S., J.-P.M., J.-P.E., A.C.); Sudden Death Expertise Center, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); and Cardiology Department, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris (C.S.).
authors.forename: Frédéric
authors.initials: F
authors.lastname: Pène
authors.affiliation: From the Medical Intensive Care Unit (G.G., W.B., F. Daviaud, F.P., J.-D.C., J.-P.M., A.C.), Emergency Department (F. Dumas), and Cardiology Department (O.V.), Cochin Hospital, Assistance Publique Hôpitaux de Paris; Emergency Medical Service, SAMU 75 (L.L.); INSERM, UMR-S970, Paris Cardiovascular Research Centre, Department of Epidemiology, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (G.G., F. Dumas, W.B., O.V., F. Daviaud, F.P., L.L., J.-D.C., C.S., J.-P.M., J.-P.E., A.C.); Sudden Death Expertise Center, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); and Cardiology Department, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris (C.S.).
authors.forename: Lionel
authors.initials: L
authors.lastname: Lamhaut
authors.affiliation: From the Medical Intensive Care Unit (G.G., W.B., F. Daviaud, F.P., J.-D.C., J.-P.M., A.C.), Emergency Department (F. Dumas), and Cardiology Department (O.V.), Cochin Hospital, Assistance Publique Hôpitaux de Paris; Emergency Medical Service, SAMU 75 (L.L.); INSERM, UMR-S970, Paris Cardiovascular Research Centre, Department of Epidemiology, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (G.G., F. Dumas, W.B., O.V., F. Daviaud, F.P., L.L., J.-D.C., C.S., J.-P.M., J.-P.E., A.C.); Sudden Death Expertise Center, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); and Cardiology Department, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris (C.S.).
authors.forename: Jean-Daniel
authors.initials: JD
authors.lastname: Chiche
authors.affiliation: From the Medical Intensive Care Unit (G.G., W.B., F. Daviaud, F.P., J.-D.C., J.-P.M., A.C.), Emergency Department (F. Dumas), and Cardiology Department (O.V.), Cochin Hospital, Assistance Publique Hôpitaux de Paris; Emergency Medical Service, SAMU 75 (L.L.); INSERM, UMR-S970, Paris Cardiovascular Research Centre, Department of Epidemiology, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (G.G., F. Dumas, W.B., O.V., F. Daviaud, F.P., L.L., J.-D.C., C.S., J.-P.M., J.-P.E., A.C.); Sudden Death Expertise Center, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); and Cardiology Department, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris (C.S.).
authors.forename: Christian
authors.initials: C
authors.lastname: Spaulding
authors.affiliation: From the Medical Intensive Care Unit (G.G., W.B., F. Daviaud, F.P., J.-D.C., J.-P.M., A.C.), Emergency Department (F. Dumas), and Cardiology Department (O.V.), Cochin Hospital, Assistance Publique Hôpitaux de Paris; Emergency Medical Service, SAMU 75 (L.L.); INSERM, UMR-S970, Paris Cardiovascular Research Centre, Department of Epidemiology, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (G.G., F. Dumas, W.B., O.V., F. Daviaud, F.P., L.L., J.-D.C., C.S., J.-P.M., J.-P.E., A.C.); Sudden Death Expertise Center, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); and Cardiology Department, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris (C.S.).
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Mira
authors.affiliation: From the Medical Intensive Care Unit (G.G., W.B., F. Daviaud, F.P., J.-D.C., J.-P.M., A.C.), Emergency Department (F. Dumas), and Cardiology Department (O.V.), Cochin Hospital, Assistance Publique Hôpitaux de Paris; Emergency Medical Service, SAMU 75 (L.L.); INSERM, UMR-S970, Paris Cardiovascular Research Centre, Department of Epidemiology, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (G.G., F. Dumas, W.B., O.V., F. Daviaud, F.P., L.L., J.-D.C., C.S., J.-P.M., J.-P.E., A.C.); Sudden Death Expertise Center, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); and Cardiology Department, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris (C.S.).
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Empana
authors.affiliation: From the Medical Intensive Care Unit (G.G., W.B., F. Daviaud, F.P., J.-D.C., J.-P.M., A.C.), Emergency Department (F. Dumas), and Cardiology Department (O.V.), Cochin Hospital, Assistance Publique Hôpitaux de Paris; Emergency Medical Service, SAMU 75 (L.L.); INSERM, UMR-S970, Paris Cardiovascular Research Centre, Department of Epidemiology, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (G.G., F. Dumas, W.B., O.V., F. Daviaud, F.P., L.L., J.-D.C., C.S., J.-P.M., J.-P.E., A.C.); Sudden Death Expertise Center, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); and Cardiology Department, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris (C.S.). Alain.cariou@cch.aphp.fr.
authors.forename: Alain
authors.initials: A
authors.lastname: Cariou
mesh_terms: D000368:Aged; D015331:Cohort Studies; D017023:Coronary Angiography; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D057216:Propensity Score; D011446:Prospective Studies; D012151:Resuscitation; D016019:Survival Analysis; D013997:Time Factors
keywords: cardiac arrest; coronary angiography; long-term outcome; percutaneous coronary intervention; therapeutic hypothermia