Impact of routine percutaneous coronary intervention after out-of-hospital cardiac arrest due to ventricular fibrillation

Abstract

IntroductionSince 2003, we have routinely used percutaneous coronary intervention (PCI) and mild therapeutic hypothermia (MTH) to treat patients < 80 years of age after out-of-hospital cardiac arrest (OHCA) related to ventricular fibrillation. The aim of our study was to evaluate the prognostic impact of routine PCI in association with MTH and the potential influence of age.MethodsWe studied 111 consecutive patients resuscitated successfully following OHCA related to shock-sensitive rhythm. They were divided into five groups according to age: < 45 years (n = 22, group 1), 45 to 54 years (n = 27, group 2), 55 to 64 years (n = 22, group 3), 65 to 74 years (n = 23, group 4) and ≥75 years (n = 17, group 5). Emergency coronary angiography was performed in hemodynamically stable patients < 80 years old, regardless of the electrocardiogram pattern. MTH was targeted to a core temperature of 32°C to 34°C for 24 hours.ResultsMost patients (73%) had coronary heart disease, although its incidence in group 1 was lower than in other groups (41% versus 81%; P = 0.01). In group 1, all patients but one underwent coronary angiography, and 33% of them underwent associated PCI. In group 5, only 53% of patients underwent a coronary angiography and 44% underwent PCI. Overall in-hospital survival was 54%, ranging between 52% and 64% in groups 1 to 4 and 24% in group 5. Time from collapse to return of spontaneous circulation was associated with mortality (odds ratio (OR) = 1.05 (25th to 75th percentile range, 1.03 to 1.08); P < 0.001), whereas PCI was associated with survival (OR = 0.30 (25th to 75th percentile range, 0.11 to 0.79); P = 0.01).ConclusionsWe suggest that routine coronary angiography with potentially associated PCI may favorably alter the prognosis of resuscitated patients with stable hemodynamics who are treated with MTH after OHCA related to ventricular fibrillation. Although age was not an independent cause of death, the clinical relevance of this therapeutic strategy remains to be determined in older people.

Impact of Percutaneous Coronary Intervention on in Hospital Mortality in Cardiac Arrest – A National Perspective

“…Result of our study clearly demonstrated improved survival with PCI in cardiac arrest patients, which were also shown in previous studies [5][6][7][8][9][10]24,25]. Statistical significant mortality benefit was also shown to be present in important subgroups including patients presenting with shock, without shock, patients with shockable rhythms (Vtach/Vfib), patients with non-shockable rhythms (Asystole/PEA), older patients (≥80 years ) and patients with high burden of comorbidities as indicated by CCI ≥ 2.…”

“…Numerous studies have been done to establish the role of PCI in post-cardiac arrest patients but outcome is still debatable. There are studies which showed improved survival in patients receiving PCI [5][6][7][8][9][10], on the other hand, some studies showed benefits only in STEMI patients [11,12]. Bulut et al [13] found no mortality benefit of performing PCI at all.…”

Predicting the Presence of an Acute Coronary Lesion Among Patients Resuscitated From Cardiac Arrest

“…6,[11][12][13] Despite this, ST-elevations are one of the most important determinants of whether a resuscitated patient undergoes emergent angiography in contemporary clinical practice. 26 In the present study, ST-elevations have a moderate discriminatory ability for an acute culprit lesion.…”

“…Previous research has demonstrated that a standard ECG has a poor negative predictive value for the presence of an acute coronary lesion in those resuscitated from a cardiac arrest. 6,[11][12][13] Further, symptom reporting in this setting is not uniform and often dependent on the presence of bystanders witnessing the event. The decision to proceed with emergent coronary angiography is thus often made with incomplete information.…”

Coronary angiography and percutaneous coronary intervention after out-of-hospital cardiac arrest: major leaps towards improved survival?

“…The study reports on trends of the application of coronary angiography (CAG) and percutaneous coronary intervention (PCI), as well as outcome after OHCA (1). Evidence that CAG may reduce mortality in OHCA patients with and without ST-segment elevation (STE) myocardial infarction (STEMI) was obtained in several previous observational studies (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). Based on these studies the current guidelines recommend emergent CAG in OHCA patients with suspected cardiac ethology of arrest and STE on ECG (class of recommendation I, level of evidence B).…”