title: Trends and Outcomes of Coronary Angiography and Percutaneous Coronary Intervention After Out-of-Hospital Cardiac Arrest Associated With Ventricular Fibrillation or Pulseless Ventricular Tachycardia.
abstract: The 2015 cardiopulmonary resuscitation and emergency cardiovascular care guidelines recommend performing coronary angiography in resuscitated patients after cardiac arrest with or without ST-segment elevation (STE).
  
  
  
  To assess the temporal trends, predictors, and outcomes of performing coronary angiography and percutaneous coronary intervention (PCI) in patients resuscitated after out-of-hospital cardiac arrest (OHCA) with initial rhythms of ventricular tachycardia or pulseless ventricular fibrillation (VT/VF).
  
  
  
  An observational analysis of the use of coronary angiography and PCI in 407 974 patients hospitalized after VT/VF OHCA from January 1, 2000, through December 31, 2012, from the Nationwide Inpatient Sample database. Multivariable analysis was used to assess factors associated with coronary angiography and PCI use. Data analysis was performed from December 12, 2015, to January 5, 2016.
  
  
  
  Temporal trends of coronary angiography, PCI, and survival to discharge in patients with VT/VF OHCA.
  
  
  
  Among the 407 974 patients hospitalized after VT/VF OHCA, 143 688 (35.2%) were selected to undergo coronary angiography. The mean (SD) age of the total population was 65.7 (14.9) years, 37.9% were female, and 74.1% were white, 13.4% black, 6.8% Hispanic, and 5.7% other race. Use of coronary angiography increased from 27.2% in 2000 to 43.9% in 2012 (odds ratio, 2.47; 95% CI, 2.25-2.71; P for trend < .001), and PCI increased from 9.5% in 2000 to 24.1% in 2012 (odds ratio, 4.80; 95% CI, 4.21-5.66; P for trend < .001). From 2000 to 2012, coronary angiography and PCI after VT/VF OHCA increased in patients with STE (53.7% to 87.2%, P for trend < .001, and 29.7% to 77.3%, P for trend < .001, respectively) and those without STE (19.3% to 33.9%, P for trend < .001, and 3.5% to 11.8%, P for trend < .001, respectively). There was an associated increasing trend in survival to discharge in the overall population of patients with VT/VF OHCA (46.9% to 60.1%, P for trend < .001) in those with STE (59.2% to 74.3%, P for trend < .001) or without STE (43.3% to 56.8%, P for trend < .001).
  
  
  
  Coronary angiography, PCI, and survival to discharge have increased in VT/VF OHCA survivors from event to hospitalization. However, a significant proportion of patients with VT/VF OHCA, especially those without STE, do not undergo coronary angiography and revascularization. Prospective studies are needed to determine whether this limitation has a survival effect.
authors.affiliation: Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Nish
authors.initials: N
authors.lastname: Patel
authors.affiliation: Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Nileshkumar J
authors.initials: NJ
authors.lastname: Patel
authors.affiliation: Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Conrad J
authors.initials: CJ
authors.lastname: Macon
authors.affiliation: Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Badal
authors.initials: B
authors.lastname: Thakkar
authors.affiliation: Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Maheshkumar
authors.initials: M
authors.lastname: Desai
authors.affiliation: Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Pablo
authors.initials: P
authors.lastname: Rengifo-Moreno
authors.affiliation: Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Alfonso
authors.affiliation: Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Myerburg
authors.affiliation: Brigham and Woman's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Mauricio G
authors.initials: MG
authors.lastname: Cohen
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular; D014693:Ventricular Fibrillation