title: Emergency Percutaneous Coronary Intervention in Post-Cardiac Arrest Patients Without ST-Segment Elevation Pattern: Insights From the PROCAT II Registry.
abstract: In a large cohort of out-of-hospital cardiac arrest (OHCA) patients without ST-segment elevation (STE), the study assessed the relationship between the use of an early invasive strategy and patient outcome.
  
  
  
  Emergent coronary angiogram (CAG) and reperfusion are currently a standard of care in patients resuscitated from an OHCA with ST-segment elevation (STE). However, using a similar invasive strategy is still debated in patients without STE.
  
  
  
  In the absence of an obvious extracardiac cause, for many years our practice has had to perform an emergent CAG in all OHCA patients (STE and no STE) at admission, followed by percutaneous coronary intervention (PCI) when required. All patients' characteristics are prospectively collected in the PROCAT (Parisian Registry Out-of-Hospital Cardiac Arrest) database. Focusing on non-STE patients and using logistical regression, we investigated the association between early PCI and favorable outcome (cerebral performance category 1 to 2 at discharge) and we searched predictive factors for PCI requirement.
  
  
  
  During the study period (2004 to 2013), we investigated 958 OHCA patients with an emergent CAG. Among them 695 of 958 (73%), mostly male (76%), and average 60 years of age had no evidence of STE on the post-resuscitation electrocardiography. A PCI was deemed necessary in 199 of 695 (29%). A favorable outcome was observed in 87 of 200 (43%) in patients with PCI compared with 164 of 495 (33%) in patients without PCI (p = 0.02). After adjustment, PCI was associated with a better outcome (adjusted odds ratio: 1.80 [95% confidence interval: 1.09 to 2.97]; p = 0.02). The other predictive factors of favorable outcome were a shorter resuscitation length (<20 min), an initial shockable rhythm, and a lower dose of epinephrine during resuscitation (p < 0.001). An initial shockable rhythm (adjusted odds ratio: 2.83 [95% confidence interval: 1.84 to 4.36]; p < 0.001) was the sole independent indicator for PCI requirement.
  
  
  
  A culprit coronary lesion requiring PCI was found in nearly one-third of OHCA patients without STE. In these patients, emergent PCI was associated with a nearly 2-fold increase in the rate of favorable outcome. These findings support the use of an invasive strategy in these patients, particularly in those resuscitated from a shockable rhythm.
authors.affiliation: INSERM U970 (team 4), Parisian Cardiovascular Research Center-PARCC, Paris Descartes University, Paris, France; Emergency Department, Cochin-Hotel-Dieu Hospital, APHP & Paris Descartes University, Paris, France. Electronic address: florence.dumas@cch.aphp.fr.
authors.forename: Florence
authors.initials: F
authors.lastname: Dumas
authors.affiliation: INSERM U970 (team 4), Parisian Cardiovascular Research Center-PARCC, Paris Descartes University, Paris, France; Medical Intensive Care Unit, Cochin University Hospital, APHP & Paris Descartes University, Paris, France.
authors.forename: Wulfran
authors.initials: W
authors.lastname: Bougouin
authors.affiliation: INSERM U970 (team 4), Parisian Cardiovascular Research Center-PARCC, Paris Descartes University, Paris, France; Medical Intensive Care Unit, Cochin University Hospital, APHP & Paris Descartes University, Paris, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Geri
authors.affiliation: INSERM U970 (team 4), Parisian Cardiovascular Research Center-PARCC, Paris Descartes University, Paris, France; Emergency Medical Services, SAMU 75, Necker Hospital, APHP & Paris Descartes University, Paris, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Lamhaut
authors.affiliation: Department of Cardiology, Cochin Hospital, APHP & Paris Descartes University, Paris, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Rosencher
authors.affiliation: Medical Intensive Care Unit, Cochin University Hospital, APHP & Paris Descartes University, Paris, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Pène
authors.affiliation: Medical Intensive Care Unit, Cochin University Hospital, APHP & Paris Descartes University, Paris, France.
authors.forename: Jean-Daniel
authors.initials: JD
authors.lastname: Chiche
authors.affiliation: Department of Cardiology, Cochin Hospital, APHP & Paris Descartes University, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Varenne
authors.affiliation: Emergency Medical Services, SAMU 75, Necker Hospital, APHP & Paris Descartes University, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Carli
authors.affiliation: INSERM U970 (team 4), Parisian Cardiovascular Research Center-PARCC, Paris Descartes University, Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Jouven
authors.affiliation: Medical Intensive Care Unit, Cochin University Hospital, APHP & Paris Descartes University, Paris, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Mira
authors.affiliation: INSERM U970 (team 4), Parisian Cardiovascular Research Center-PARCC, Paris Descartes University, Paris, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Spaulding
authors.affiliation: INSERM U970 (team 4), Parisian Cardiovascular Research Center-PARCC, Paris Descartes University, Paris, France; Medical Intensive Care Unit, Cochin University Hospital, APHP & Paris Descartes University, Paris, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Cariou
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D004630:Emergencies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D058687:Out-of-Hospital Cardiac Arrest / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D010297:Paris; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: cardiac arrest; coronary angiogram; percutaneous coronary intervention