Immediate complete revascularization showed better outcome in out-of-hospital cardiac arrest survivors with left main or triple-vessel coronary diseases

Abstract

This study aimed to evaluate the prevalence of left main or triple vessel coronary artery disease (CAD) in comatose out-of-hospital cardiac arrest (OHCA) survivors and assessed their outcome based on the revascularization strategy. This multicenter, retrospective, observational registry-based study was conducted at 9 Korean tertiary care hospitals. Adult comatose OHCA survivors with left main or triple vessel CAD documented by immediate (≤ 2 h) coronary angiography after return of spontaneous circulation between 2011 and 2019 were included. The primary outcome was neurologically intact survival at 1-month. Among 727 OHCA patients, 150 (25%) had left main or triple vessel CAD and underwent complete (N = 32), incomplete (N = 78), and no immediate (N = 40) revascularization, respectively. The rate of neurologically intact survival at 1 month was significantly different among the groups (53%, 32%, and 23% for complete, incomplete, and no immediate revascularization groups, respectively; P = 0.02). After adjustment using the inverse probability of treatment weighting, complete revascularization was associated with neurologically intact survival at 1 month (odds ratio, 2.635; P = 0.01). Left main or triple vessel CAD is not uncommon in OHCA patients. The complete revascularization was associated with better outcome. Further clinical trials to confirm the best revascularization strategy are needed.

Risk factors for sudden cardiac arrest in patients with ST-segment elevation myocardial infarction: a retrospective cohort study

“…They also reported a higher mortality rate and CPC score in patients with asystole as the initial rhythm, reduced ejection fraction (< 30%) and creatinine level (> 1.3 mg/dL) on admission, and vasopressor usage on admission [ 6 ]. Kim et al reported inferior neurological function in OHCA patients with left main CAD or three-vessel disease who did not receive complete revascularization [ 21 ]; similar results were also noted in this study. Our study revealed that older age, longer CPR duration, and high prevalence of left main CAD and three-vessel disease were associated with a lower survival-to-discharge rate and inferior favorable neurological function in patients with STEMI and SCA.…”

Risk factors for sudden cardiac arrest in patients with ST-segment elevation myocardial infarction: a retrospective cohort study

“…They also reported a higher mortality rate and CPC score in patients with asystole as the initial rhythm, reduced ejection fraction (< 30%) and creatinine level (> 1.3 mg/dL) on admission, and vasopressor usage on admission [6]. Kim et al reported inferior neurological function in OHCA patients with left main CAD or three-vessel disease who did not receive complete revascularization[17]; similar results were also noted in this study. Our study revealed that older age, longer CPR duration, and high prevalence of left main CAD and three-vessel disease were associated with a lower survival-to-discharge rate and inferior favorable neurological function in patients with STEMI and SCA.…”

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

“…They showed that in-hospital mortality among cardiac arrest survivors with multivessel lesions is lower if complete revascularization is performed. The second is a multicentre retrospective study by Kim et al [ 26 ] reporting data from a population similar in size to our, although multicentre, with a follow up but still limited to one month after hospital discharge. They also found that a complete revascularization strategy allows better survival.…”