title: Distance to invasive heart centre, performance of acute coronary angiography, and angioplasty and associated outcome in out-of-hospital cardiac arrest: a nationwide study.
abstract: OBJECTIVE
  To evaluate whether the distance from the site of event to an invasive heart centre, acute coronary angiography (CAG)/percutaneous coronary intervention (PCI) and hospital-level of care (invasive heart centre vs. local hospital) is associated with survival in out-of-hospital cardiac arrest (OHCA) patients.
  
  
  RESULTS
  Nationwide historical follow-up study of 41 186 unselected OHCA patients, in whom resuscitation was attempted between 2001 and 2013, identified through the Danish Cardiac Arrest Registry. We observed an increase in the proportion of patients receiving bystander CPR (18% in 2001, 60% in 2013, P < 0.001), achieving return of spontaneous circulation (ROSC) (10% in 2001, 29% in 2013, P < 0.001) and being admitted directly to an invasive centre (26% in 2001, 45% in 2013, P < 0.001). Simultaneously, 30-day survival rose from 5% in 2001 to 12% in 2013, P < 0.001. Among patients achieving ROSC, a larger proportion underwent acute CAG/PCI (5% in 2001, 27% in 2013, P < 0.001). The proportion of patients undergoing acute CAG/PCI annually in each region was defined as the CAG/PCI index. The following variables were associated with lower mortality in multivariable analyses: direct admission to invasive heart centre (HR 0.91, 95% CI: 0.89-0.93), CAG/PCI index (HR 0.33, 95% CI: 0.25-0.45), population density above 2000 per square kilometre (HR 0.94, 95% CI: 0.89-0.98), bystander CPR (HR 0.97, 95% CI: 0.95-0.99) and witnessed OHCA (HR 0.87, 95% CI: 0.85-0.89), whereas distance to the nearest invasive centre was not associated with survival.
  
  
  CONCLUSIONS
  Admission to an invasive heart centre and regional performance of acute CAG/PCI were associated with improved survival in OHCA patients, whereas distance to the invasive centre was not. These results support a centralized strategy for immediate post-resuscitation care in OHCA patients.
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8280 Aarhus N, Denmark.
authors.forename: Tinne
authors.initials: T
authors.lastname: Tranberg
authors.affiliation: Prehospital Emergency Medical Services, The Capital Region of Denmark.
authors.forename: Freddy K
authors.initials: FK
authors.lastname: Lippert
authors.affiliation: Prehospital Emergency Medical Services, The North Denmark Region, Aalborg.|Department of Anaesthesiology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Erika F
authors.initials: EF
authors.lastname: Christensen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8280 Aarhus N, Denmark.
authors.forename: Carsten
authors.initials: C
authors.lastname: Stengaard
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8280 Aarhus N, Denmark.
authors.forename: Jakob
authors.initials: J
authors.lastname: Hjort
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8280 Aarhus N, Denmark.
authors.forename: Jens Flensted
authors.initials: JF
authors.lastname: Lassen
authors.affiliation: The Heart Centre, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.
authors.forename: Frants
authors.initials: F
authors.lastname: Petersen
authors.affiliation: Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark.
authors.forename: Jan Skov
authors.initials: JS
authors.lastname: Jensen
authors.affiliation: Department of Cardiothoracic Surgery, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Caroline
authors.initials: C
authors.lastname: Bäck
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Lisette Okkels
authors.initials: LO
authors.lastname: Jensen
authors.affiliation: Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Jan
authors.initials: J
authors.lastname: Ravkilde
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8280 Aarhus N, Denmark.
authors.forename: Hans Erik
authors.initials: HE
authors.lastname: Bøtker
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8280 Aarhus N, Denmark.
authors.forename: Christian Juhl
authors.initials: CJ
authors.lastname: Terkelsen
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000401:mortality / Q000592:standards / Q000706:statistics & numerical data; D017023:Coronary Angiography / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D003325:Coronary Care Units / Q000592:standards / Q000706:statistics & numerical data; D003422:Critical Care / Q000592:standards / Q000706:statistics & numerical data; D003718:Denmark / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000401:mortality / Q000592:standards / Q000706:statistics & numerical data; D012111:Residence Characteristics; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality / Q000628:therapy; D061665:Time-to-Treatment / Q000592:standards / Q000706:statistics & numerical data; D014195:Travel; D016896:Treatment Outcome
keywords: 30-day survival; Acute CAG/PCI ; Distance from the site of arrest to invasive heart centre ; Hospital-level-of-care ; Population density ;  Out-of-hospital cardiac arrest 