Complete Revascularization and One-Year Survival with Good Neurological Outcome in Patients Resuscitated from an Out-of-Hospital Cardiac Arrest

Abstract

Background. The survival benefit of complete versus infarct-related artery (IRA)-only revascularization during the index hospitalization in patients resuscitated from an out-of-hospital cardiac arrest (OHCA) with multivessel disease is unknown. Methods. We considered all the OHCA patients prospectively enrolled in the Lombardia Cardiac Arrest Registry (Lombardia CARe) from 1 January 2015 to 1 May 2021 who underwent coronary angiography (CAG) at the Fondazione IRCCS Policlinico San Matteo (Pavia). Patients’ prehospital, angiographical and survival data were reviewed. Results. Out of 239 patients, 119 had a multivessel coronary disease: 69% received IRA-only revascularization, and 31% received a complete revascularization: 8 during the first procedure and 29 in a staged-procedure after a median time of 5 days [IQR 2.5–10.3]. The complete revascularization group showed significantly higher one-year survival with good neurological outcome than the IRA-only group (83.3% vs. 30.4%, p < 0.001). After correcting for cardiac arrest duration, shockable presenting rhythm, peak of Troponin-I, creatinine on admission and the need for circulatory support, complete revascularization was independently associated with the probability of death and poor neurological outcome [HR 0.3 (95%CI 0.1–0.8), p = 0.02]. Conclusions. This observation study shows that complete myocardial revascularization during the index hospitalization improves one-year survival with good neurological outcome in patients resuscitated from an OHCA with multivessel coronary disease.

Updates on Post-Resuscitation Care. After the Return of Spontaneous Circulation beyond the 2021 Guidelines

“…When it comes to patients after cardiac arrest there are no recommendations available on revascularization strategy in case of coronary multivessel disease. A recent retrospective study from our group [ 28 ] suggested that survival with good neurologic outcome of patients who received a complete revascularization, either during the index or staged procedure during the index hospitalization, was higher than the IRA-only group (83.3% vs. 30.4%, p 0.001). Even after correction for renal function, cardiac arrest duration, shockable rhythm, and the need for a pharmacologic or mechanical circulatory support a complete revascularization was confirmed to be independently associated with survival [HR 3 (95% CI 1.1–10), p = 0.04].…”